Nicklaus Children's Health System
Authorization Specialist- Case Manager (Full Time, Days)
Nicklaus Children's Health System, Fort Lauderdale, Florida, us, 33336
Authorization Specialist – Case Manager (Full Time, Days)
Location: Nicklaus Children’s Hospital – Coral Springs & Broward Health Medical Center.
Job Summary Responsible for insurance verification and obtaining authorization for inpatient, outpatient, observation, extended stay outpatient in bed, and inpatient admissions including concurrent authorization requests, retroactive authorization modifications, and discharge notifications as appropriate. Works in conjunction with UM Coordinator for the management of denials.
Job Specific Duties
Communicates to clinical team and other departments managed care requests via established work flows.
Provides and documents adequate notification, accurate records of insurance notes, denials, and authorizations.
Responds to inquiries, and escalates as appropriate any authorization issues or denials.
Monitors admissions, continued-stay, and discharge patients to ensure accurate authorizations are obtained.
Secures authorization for all inpatient admissions, outpatient, and elective extended procedures stay in a bed.
Verifies insurance benefits documents accurately in computer system.
Provides verifications and authorizations within 24 hours of in‑patient‑bed assignment.
Reconciles "Discharge Not Final Bill" encounters, and documents in approved computer system authorization status within established timeframe.
Reconciles daily/weekly census with managed care companies.
Minimum Job Requirements
2 years of customer service experience.
2 years of experience with health plans, Medicaid, commercial payers, and Marketplace.
Knowledge, Skills, And Abilities
High school education or equivalent preferred.
One year of experience working with medical terminology, procedures, diagnosis codes, and insurance preferred.
Prior experience working with CPT and ICD-10 coding preferred.
Intermediate proficiency in Microsoft Word, Excel, and Outlook.
Able to communicate effectively both verbally and in writing in a clear, concise, courteous, and prompt manner with all internal and external customers.
Fluent in Spanish preferred.
Able to maintain confidentiality of sensitive information.
Able to work in a fast‑paced environment and possesses strong organizational skills including priority setting, planning, decision making, and effective management and use of resources to meet competing deadlines.
Able to work in a team, build consensus, influence others, and handle conflicts with tact.
Able to establish necessary professional relationships, and interact effectively with internal and external customers.
Able to adapt and react calmly under stressful conditions in a pleasant manner.
Able to learn work‑related software applications and effectively use them.
Department BHMC SOCIAL SERVICES - 2200-866010
Job Status Full Time
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Job Summary Responsible for insurance verification and obtaining authorization for inpatient, outpatient, observation, extended stay outpatient in bed, and inpatient admissions including concurrent authorization requests, retroactive authorization modifications, and discharge notifications as appropriate. Works in conjunction with UM Coordinator for the management of denials.
Job Specific Duties
Communicates to clinical team and other departments managed care requests via established work flows.
Provides and documents adequate notification, accurate records of insurance notes, denials, and authorizations.
Responds to inquiries, and escalates as appropriate any authorization issues or denials.
Monitors admissions, continued-stay, and discharge patients to ensure accurate authorizations are obtained.
Secures authorization for all inpatient admissions, outpatient, and elective extended procedures stay in a bed.
Verifies insurance benefits documents accurately in computer system.
Provides verifications and authorizations within 24 hours of in‑patient‑bed assignment.
Reconciles "Discharge Not Final Bill" encounters, and documents in approved computer system authorization status within established timeframe.
Reconciles daily/weekly census with managed care companies.
Minimum Job Requirements
2 years of customer service experience.
2 years of experience with health plans, Medicaid, commercial payers, and Marketplace.
Knowledge, Skills, And Abilities
High school education or equivalent preferred.
One year of experience working with medical terminology, procedures, diagnosis codes, and insurance preferred.
Prior experience working with CPT and ICD-10 coding preferred.
Intermediate proficiency in Microsoft Word, Excel, and Outlook.
Able to communicate effectively both verbally and in writing in a clear, concise, courteous, and prompt manner with all internal and external customers.
Fluent in Spanish preferred.
Able to maintain confidentiality of sensitive information.
Able to work in a fast‑paced environment and possesses strong organizational skills including priority setting, planning, decision making, and effective management and use of resources to meet competing deadlines.
Able to work in a team, build consensus, influence others, and handle conflicts with tact.
Able to establish necessary professional relationships, and interact effectively with internal and external customers.
Able to adapt and react calmly under stressful conditions in a pleasant manner.
Able to learn work‑related software applications and effectively use them.
Department BHMC SOCIAL SERVICES - 2200-866010
Job Status Full Time
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