Health First
Clinical Authorization Specialist HFMG - Oncology
Health First, Melbourne, Florida, United States, 32935
Clinical Authorization Specialist HFMG - Oncology
Join to apply for the
Clinical Authorization Specialist HFMG - Oncology
role at
Health First .
The Clinical Authorization Specialist provides a comprehensive, accurate, and timely review of insurance benefits, submissions for authorizations, and creation of cost estimates.
Job Requirements Position Title: Clinical Authorization Specialist HFMG
Position Of Report: Manager
Job Code: 002135
Department: Oncology
Division: Community Health Services
Original Date: Nov 2025
Primary Accountabilities
Gathers prior authorization, precertification, and pre-determination applicable services (such as office visits, injectables, etc.) that require an authorization from the insurance carrier.
Contacts insurance company(s) as necessary to revise the authorization to ensure payment for services, and to request policy and coverage limits, deductible amounts, co‑pays, co‑insurance amounts, and authorization required.
Submits requested clinical documentation to the insurance company to support the medical necessity of services.
Enters all authorization information into the appropriate system to facilitate correct billing.
Identifies any insurance trends regarding insurance updates and notifies applicable parties.
Processes referrals and submits medical records to insurance carriers to expedite prior authorization processes in accordance with Health First policy and procedures.
Reviews the coding and verifies it is correct and within the guidelines dictated by CMS coding compliance standards.
Obtains insurance authorizations to ensure medical procedures being performed are consistent with the authorization.
Acquires and verifies insurance information on all patient files containing insurance.
Provides information and instructions telephonically to patients, meeting the departmental and organizational standards.
Minimum Qualifications
Education: Technical Diploma in Practical Nursing.
Work Experience: Two (2) years in healthcare.
Licensure: Licensed Practical Nurse (LPN) licensure in the State of Florida.
Certification: None.
Skills/Knowledge/Abilities:
Proficient in Microsoft Office – Outlook, Word, Excel, PowerPoint.
Working knowledge of managed care and insurance programs.
Ability to work autonomously with minimal supervision.
Ability to prioritize and organize to maximize quality, value, and service.
Ability to adapt to a potentially rapidly changing environment or work process.
Excellent teamwork and collaboration skills.
Meets and maintains productivity and quality metrics set by management.
Preferred Qualifications
Previous Medical Coding experience in ICD‑9, ICD‑10, CPT, and HCPCS.
Physical Requirements
Majority of time involves sitting or standing; occasional walking, bending, and stooping.
Long periods of computer time at a workstation.
Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
May be exposed to indoor environments with varied temperatures, air quality, lighting, and/or low to moderate noise.
Communicating with others to exchange information.
Visual acuity and hand‑eye coordination to perform tasks.
Workspace may vary from open to confined.
May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.
Benefits Schedule: Full-Time Shift Times: 8:00 AM – 5:00 PM Paygrade: 31
About Health First At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Seniority Level Entry level
Employment Type Full-time
Job Function Health Care Provider
Industries Hospitals and Health Care
#J-18808-Ljbffr
Clinical Authorization Specialist HFMG - Oncology
role at
Health First .
The Clinical Authorization Specialist provides a comprehensive, accurate, and timely review of insurance benefits, submissions for authorizations, and creation of cost estimates.
Job Requirements Position Title: Clinical Authorization Specialist HFMG
Position Of Report: Manager
Job Code: 002135
Department: Oncology
Division: Community Health Services
Original Date: Nov 2025
Primary Accountabilities
Gathers prior authorization, precertification, and pre-determination applicable services (such as office visits, injectables, etc.) that require an authorization from the insurance carrier.
Contacts insurance company(s) as necessary to revise the authorization to ensure payment for services, and to request policy and coverage limits, deductible amounts, co‑pays, co‑insurance amounts, and authorization required.
Submits requested clinical documentation to the insurance company to support the medical necessity of services.
Enters all authorization information into the appropriate system to facilitate correct billing.
Identifies any insurance trends regarding insurance updates and notifies applicable parties.
Processes referrals and submits medical records to insurance carriers to expedite prior authorization processes in accordance with Health First policy and procedures.
Reviews the coding and verifies it is correct and within the guidelines dictated by CMS coding compliance standards.
Obtains insurance authorizations to ensure medical procedures being performed are consistent with the authorization.
Acquires and verifies insurance information on all patient files containing insurance.
Provides information and instructions telephonically to patients, meeting the departmental and organizational standards.
Minimum Qualifications
Education: Technical Diploma in Practical Nursing.
Work Experience: Two (2) years in healthcare.
Licensure: Licensed Practical Nurse (LPN) licensure in the State of Florida.
Certification: None.
Skills/Knowledge/Abilities:
Proficient in Microsoft Office – Outlook, Word, Excel, PowerPoint.
Working knowledge of managed care and insurance programs.
Ability to work autonomously with minimal supervision.
Ability to prioritize and organize to maximize quality, value, and service.
Ability to adapt to a potentially rapidly changing environment or work process.
Excellent teamwork and collaboration skills.
Meets and maintains productivity and quality metrics set by management.
Preferred Qualifications
Previous Medical Coding experience in ICD‑9, ICD‑10, CPT, and HCPCS.
Physical Requirements
Majority of time involves sitting or standing; occasional walking, bending, and stooping.
Long periods of computer time at a workstation.
Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
May be exposed to indoor environments with varied temperatures, air quality, lighting, and/or low to moderate noise.
Communicating with others to exchange information.
Visual acuity and hand‑eye coordination to perform tasks.
Workspace may vary from open to confined.
May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.
Benefits Schedule: Full-Time Shift Times: 8:00 AM – 5:00 PM Paygrade: 31
About Health First At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Seniority Level Entry level
Employment Type Full-time
Job Function Health Care Provider
Industries Hospitals and Health Care
#J-18808-Ljbffr