SUMMARY: Join a compassionate and mission-driven team as a full-time Physician Practice Representative supporting a busy pediatric hematology/oncology practice at Palm Beach Children’s Hospital, located within St. Mary’s Medical Center. This position is ideal for someone who thrives in a fast-paced healthcare environment, enjoys multitasking, and takes pride in delivering exceptional patient support. You’ll play a key role in managing insurance verification, scheduling new and follow-up appointments.

• Inputs new patient information and updates information in our EMR system

• Analyzes patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization

• Ensure patients are eligible for services and that insurance benefits are accurate

• Notifies providers of potential coverage options

• Communicates with patients about the authorization process and any potential delays or financial implications.

• Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions

• Compiles and submits detailed authorization requests to insurance companies, including all necessary documentation

• Completes/obtains authorizations and referrals for services, including appointments, procedures, infusions, and medications

• Researches and resolves any issues or discrepancies related to authorization requests

• Monitors and follows up on authorization requests to ensure timely processing

• Investigates insurance denials and resubmit requests or appeals when necessary.

• Monitors schedule for potential issues

• Remains informed about healthcare industry regulations, trends and insurance policies

• Performs other related duties as assigned by management.

QUALIFICATIONS:

• High school diploma or general education degree (GED), or 2+ years related experience and/or training, or equivalent combination of education and experience.

• Computer skills required: Microsoft Outlook, Word, Excel and Adobe; Experience working with medical practice management software a plus.

• Other skills required:

• Experience working in a physician practice.

• Knowledge of medical terms and medical insurance

• Experience in requesting/submitting prior authorization for various diagnostic exams, prescriptions, etc.

• Professional demeanor and appearance.

• Strong interpersonal and communication skills.

• Meticulous attention to detail.

• Proficient in Microsoft Office Suite (Word, Excel, Outlook)

JOB TYPE / WORK SCHEDULE:

• This is a full-time position, in-office position

• Standard office hours are Monday through Friday, 8:00 a.m. – 4:30 p.m.

• Bilingual Preferred

Competitive pay and full benefits package, including 401(k), health, dental, vision, life, and disability insurance.