CCS Medical

  • Pre-Authorization Representative

    Job Location US-FL-Clearwater
    Position Status
    Regular Full-Time
    Position Schedule
    Alternative Schedule
  • Overview

    Maintains current insurance authorizations for supplies provided to new and existing CCS Medical patients.  Performs eligibility checks for Medicaid patients.


    • Essential Duties:

    • Obtains current authorizations from insurance companies, patients and physicians for items that require an authorization prior to shipment
    • Provides back-up assistance to the Billing Approval by performing more of an audit function prior to releasing shipments
    • Makes outbound calls to insurance companies, patients and physicians
    • Communicates directly with patients regarding barriers of obtaining authorization from their insurance program
    • Verifies eligibility of patient’s insurance prior to approval to ensure for reimbursement
    • Audits configuration of supplies based on testing frequencies & manufacturer to ensure quantities and brands are accurate prior to shipping.
    • Compares authorization to PWO and adjusts shipment to lowest amount indicated
    • Maintains a high level of professionalism when speaking to doctors and insurance companies
    • Maintains a high degree of confidentiality at all times due to access to sensitive information
    • Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
    • Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
    • Abides by all regulations, policies, procedures and standards


    • Performance Responsibilities:
    • Exercises appropriate cost control measures
    • Maintains positive internal and external customer service relationships
    • Maintains open lines of communication
    • Plans and organizes work effectively and ensures its completion
    • Meets all productivity requirements
    • Demonstrates team behavior and promotes a team-oriented environment
    • Actively participates in Continuous Quality Improvement
    • Represents the organization professionally at all times


    • High School diploma and one year medical insurance verification related experience or equivalent combination of education and experience
    • One year of customer service experience required
    • Bachelor’s degree preferred
    • Proficient in Microsoft Outlook, Word, Excel, PowerPoint and computer literacy
    • Knowledge of government and commercial insurance payers as it relates to documentation of claims that are required before submission
    • Ability to understand Medical Records documents such as safety rules, operating and maintenance instructions, and procedure manuals
    • Position may require evening and weekend availability
    • Strong attention to detail, multi-tasking, communication, and organizational skills are essential
    • Demonstrated ability to accurately perform data entry and pay close attention to detail

    Equal Opportunity Employer/Veterans/Disabled


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