Overview
Our client is looking for a detail-oriented Medical Insurance Specialist / Authorization Coordinator to join their team. In this role, you will streamline medical operations by managing referrals, prior authorizations, appeals, and MRI approvals across two distinct medical practices. Utilizing online insurance portals and systems like Athenahealth, you will play a crucial role in ensuring patients receive timely approvals without handling any direct appointment scheduling.

Schedule: Remote Full Time | Monday to Friday, 8:00 AM to 5:00 PM EST.

Responsibilities

• Manage insurance referrals and prior authorization processes.
• Navigate various insurance company portals to submit and track requests.
• Follow up on pending authorizations and referrals.
• Communicate approval and denial updates to the appropriate office staff.
• Maintain accurate records and update provided tracking spreadsheets.
• Handle appeals for denied referrals, procedures, medications, and imaging requests as applicable.
• Follow up on submitted appeals and provide status updates to the practices.
• Maintain confidentiality when handling patient and insurance information.

If you are selected for this position, you could be assigned to one of these practices, each one have different responsibilities:

West Palm Beach Practice

• Referrals: Obtain referrals for new and established patients for office visits. Notify office staff once referrals are obtained so appointments can be scheduled.
• Procedure Authorizations: Submit prior authorizations for ordered procedures to insurance carriers. Communicate approvals or denials to office staff.
• Appeals: File and follow up on appeals for denied procedures and provide updates to the office.
• MRI Approvals: Monitor MRI requests through the Athena tracker and contact patients once approvals are received. Appeal denials as needed and communicate updates to the office.
• Log referral, authorization, and approval information in the provided spreadsheets.

Pembroke Pines Practice

• Referrals & Procedure Authorizations: Obtain required referrals and authorizations and communicate updates to office staff so appointments can be scheduled.
• Maintain accurate authorization and referral records in the provided spreadsheet.
• File appeals for denied procedures and follow up with the insurance carrier. Notify the office if an authorization cannot be obtained.
• Medication Prior Authorizations: Submit and follow up on medication PAs. Contact patients regarding approvals and file appeals for denied medications when appropriate.
• Communicate with the office regarding next steps when medication authorization cannot be obtained.
• MRI Approvals: Monitor MRI requests through the Athena tracker, notify patients once approved, appeal denials as needed, and communicate updates to office staff.

Requirements

• Previous experience in medical insurance, prior authorizations, referrals, or healthcare administration required.
• Experience working as an authorizations coordinador is required.
• Experience navigating insurance company portals.
• Familiarity with prior authorization and appeals processes.
• Experience with Athenahealth is a plus.
• Strong follow-up and organizational skills.
• Excellent written and verbal communication.
• High attention to detail and accuracy.
• Ability to manage multiple requests and deadlines independently.
• Comfortable communicating with insurance carriers, patients, and medical office staff.

TECHNICAL REQUIREMENTS

• Windows 10 or Windows 11, Processor: Intel i5 or i7
• Memory (RAM): 16 GB
• Internet Speed: 30 Mbps or higher

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations

Note
Please click the "APPLY" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

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