HMO Specialist I – Admitting

Nemours Children’s Health Jacksonville is in search of an HMO Specialist. The HMO Specialist verifies Insurance eligibility and benefits and responsible for obtaining authorization for Office Visits, Neuro-Psychology Testing and other Behavioral Health visits and testing, Reviews Insurance Benefits and Out of Pocket responsibility with Patient Families. Works collaboratively with other Teams to ensure the efficient and effective delivery of services to all patients and clients.

The Ideal Candidate provides impeccable customer service and possesses the following Qualities:

• Initiative-taking can work independently yet be part of a team. Previous medical office experience preferred. * Experience dealing with insurance companies, verification processes, and authorizations requirements, Cheerful outlook, adapts quickly to process.
• Builds and Maintains Relationships: Seeks to understand colleagues’ priorities and working styles and develops relationships across areas.
• Communicates Effectively: Openly shares information with others and communicates in a clear and courteous manner.
• Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides correct information and support.
• Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools, or systems and displays willingness to go above and beyond.
• Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service.

Essential Functions:

• Verify insurance eligibility and obtain referrals/authorizations for Office Visits and Procedures or Equipment.
• Communicate with assigned clinical teams, patient families about un-attainable for delayed insurance referrals/authorizations.
• Monitor voice mail and return calls as appropriate for the main HMO phone line.
• Work queues: Process encounters via the DAG work queue daily.
• All other duties as assigned by supervisor or manager.

Requirements:

HS Diploma or equivalent required. One year of specialized training beyond HS required.

Customer Service and HC experience preferred.

One to three years’ experience in medical offices/call center/referral/authorization experience.

EPIC and Prior Psychology/Neuro-Psychology authorization/referral experience preferred.