Florida Orthopaedic Institute · 18 hours ago
Clinical Authorizations Representative - St. Petersburg
St. Petersburg, FL
Full-time
Onsite
Entry Level
1+ years expFlorida Orthopaedic Institute is seeking a Clinical Authorizations Representative to manage patient communications and insurance authorizations. The role involves verifying benefit coverage, ensuring timely completion of diagnostic study records, and establishing relationships with insurance carriers and medical staff.
Health CareMedical
Responsibilities
Communicates with patients over the phone in a professional and customer service oriented manner
Communicates effectively with staff, secretaries, and physicians by phone, in person or in writing
Captures the diagnostic study record for assigned clinic and becomes the record owner
Verifies benefit coverage, eligibility for diagnostic study owned in File maker prior to testing date
Ensures assigned diagnostic study records are completed in a timely manner
Determines whether the patient’s insurance company required pre-authorization and obtains all authorizations, if applicable
Able to identify the difference when a prior authorization or a referral is needed prior to the diagnostic studies being performed
Identifies, reviews, extracts, and provides clinical notes, durations and response to conservative treatment measures from patient’s visits to the insurance carrier in an effort to obtain a secure pre-authorization for the diagnostic studies
Ensures the nature and outcome of the contact with the insurance carrier of each diagnostic test request is documented in File maker, Athena to support claims billing and reimbursement of the diagnostic studies
Establishes a good working relationship with Primary Care Physicians’ offices, Insurance and various diagnostic testing facilities and hospitals
Maintains a thorough understanding of all major insurance carrier benefit verification and authorization processes. Keeps current with updates for various health plans
Maintains and utilizes online access to major insurance carriers
Seeks clarification of physician’s diagnostic study orders, if necessary
Communicates with the patient on the process of their authorization
All other duties as assigned
Qualification
Required
High School Diploma or GED is required
Previous customer service experience required
1-2 years experience in a medical environment with experience in medical insurance verification and pre-authorizations
Must be proficient in Microsoft Office applications, including Outlook, Excel, and Word
Effective written and oral communication, critical thinking and problem solving skills required
Knowledge of medical terminology and diagnostic studies
Company
Florida Orthopaedic Institute
Florida Orthopaedic Institute is a medical practice that provides orthopedic care services.
1001-5000 employees
H1B Sponsorship
Florida Orthopaedic Institute has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2022 (1)
Funding
Current Stage
Late StageLeadership Team
Janene Culumber
CFO
Harry Kimball, CPA
Chief Accounting Officer (CAO)
Recent News
2025-08-04
Business Journals
2024-05-31
The Business Journals
2024-04-09
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