LRHPG Medical Authorization Rep -

Position Details

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits. Lakeland Regional Health is currently seeking motivated individuals to join our team in various entry-level positions. Whether you're starting your career in healthcare or seeking new opportunities to make a difference, we have roles available across our primary and specialty clinics, urgent care centers, and upcoming standalone Emergency Department. With over 7,000 employees, Lakeland Regional Health offers a supportive work environment where you can thrive and grow professionally.

Active - Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 8 0.00

Shift : Monday - Friday 8:30am-5pm

Location : Hybrid

Pay Rate : Min $17.12 Mid $19.69

Position Summary

Responsible for verifying and interpreting insurance eligibility. Obtain referrals and authorization for scheduled and unscheduled patients. Utilize required electronic systems and reports to determine authorization requirements. Possesses and maintains knowledge of authorization processes and functions, the managed care environment, third party reimbursement, CMS rules and regulation regarding physician coverage and healthcare policies. Capable of articulating information in a clear and informative manner to clinical staff, hospital personnel, insurance representatives, physicians and business office management. Work independently; demonstrate result and solution oriented characteristics.

Position Responsibilities

Standard Work Duties: LRHPG Medical Authorization Representative

• Obtains, interprets and submits clinical documentation pertinent to specific service requiring prior authorization/referral to support medical necessity review by the payer
• Obtains referrals and/or authorization, including the necessary information for authorization or referral as required by utilizing electronic methods, contacting the insurance company, physician's office or patient.
• Ensures all authorization/referral documents are scanned into Practice Management system
• Collaborates with Coders, and Clinic Staff, and gather information related to services needing authorization.
• Responsible for performing all automated functions for insurance verification and eligibility, authorization and other ambulatory business office processes as needed prior to the patient presenting for services.
• Stewardship
• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities. Knows and adheres to organizational and department policies and procedures.

Competencies & Skills

Essential:

• Demonstrate knowledge and understanding of ICD-9 / ICD-10 and CPT codes.
• Knowledge of medical terminology.
• Excellent customer service skills
• Excellent written and verbal communication skills.
• Excellent computer skills to include Word, Excel and any other healthcare registration or billing and collections applications.

Nonessential: Completion of Basic Human Anatomy and Medical Terminology course.

Qualifications & Experience

Essential:

• High School or Equivalent

Nonessential: Associate Degree

Nonessential:

Business or Healthcare Administration

Other information:

Certifications Preferred: Member of AAPC or PAHCOM

Experience Essential: One to three years of experience in obtaining authorization, managing referrals and/or billing and collections in a professional physician office setting.