[Hiring] Insurance Authorization Coordinator I @Nemours Children's Health

Role Description

Nemours is seeking an Insurance Authorization Coordinator, I FULL-TIME, to join our team in Orlando, Florida. The Insurance Authorization Coordinator I is responsible for obtaining authorizations for hospital-based and/or physician-based services.

• Utilizes workqueues & other mechanisms to initiate the authorization and/or referral.
• Follows up, monitors appointments add-ons, and documents any changes available for the initial authorization and/or referral request.
• Completes authorizations/referrals based on departmental goals and guidelines.
• Utilizes all available resources to verify eligibility, authorization requirements, and plan benefit levels.
• Ensures accurate financial collections through a detailed benefit collection process.

Qualifications

• High School Diploma required.
• Six (6) months to two (2) years of authorization experience required.
• Must have knowledge of insurance plans and third-party payor requirements.
• Understanding of CPT, ICD 10 codes, and basic medical terminology required.
• Knowledge of role appropriate Epic Applications.
• Knowledge of Microsoft Word, Excel, and Outlook.

Requirements

• Ability to request and obtain preauthorization for assigned specialties.
• Ensure requests for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements.
• Verify patients’ insurance coverage, eligibility, demographics, benefits, and financial responsibility.
• Stay up to date with insurance policies, guidelines, and procedures related to authorization and reimbursement processes.
• Process appointment or appointment add-ons, changes to previously scheduled services, and impactful service changes.
• Communicate with patients, their families, and healthcare professionals regarding authorization requests.
• Maintain accurate and detailed records of authorization requests, approvals, denials, and related correspondence.
• Collaborate with healthcare providers, physicians, and clinical staff.
• Identify and address barriers or challenges during the authorization process.
• Attend and participate in daily departmental huddles to report on payer issues and workflow barriers.
• Build and maintain professional, cooperative relationships with contacts from specialty departments.
• Adhere to relevant laws, regulations, and privacy guidelines when handling patient information.
• Other duties as assigned.

Benefits

• Competitive base compensation in the top quartile of the market.
• Annual incentive compensation that values clinical activity, academic accomplishments, and quality improvement.
• Comprehensive benefits: health, life, dental, vision.
• 403B with employer match.
• Licensure, CME, and dues allowance.
• Not-for-profit status; eligibility for Public Service Loan Forgiveness.
• No state income tax for those living and working in Florida.
• Moderate tax structure for those based in Delaware.

Company Description

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children’s hospitals — Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida — along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships.

Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive.

Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.

Learn more at Nemours.org .