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Full Time Prior Authorization Rn Jobs in Florida

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Full Time Prior Authorization Rn information

What is a full time prior authorization RN?

Full Time Prior Authorization Registered Nurses (RNs) are healthcare professionals who work primarily in administrative roles to review and evaluate medical service requests. Their main responsibility is to determine if specific treatments, medications, or procedures meet insurance company criteria for coverage before they are provided to patients. They use their clinical knowledge to assess medical necessity and ensure compliance with healthcare policies and guidelines. These nurses typically interact with physicians, insurance companies, and patients to manage authorizations and appeals, ensuring that care is both appropriate and covered under a patient’s health plan.

What are some typical challenges faced by full time prior authorization RNs, and how can they be managed?

Full Time Prior Authorization RNs often encounter challenges related to navigating complex insurance guidelines, managing high caseloads, and ensuring timely communication between healthcare providers and payers. Staying organized, keeping up-to-date with frequently changing insurance policies, and developing strong collaboration skills with both clinical and administrative teams are key to success in this role. Leveraging electronic health records and standardized workflows can also help streamline the authorization process and reduce delays for patients.

What are the key skills and qualifications needed to thrive as a full time prior authorization RN, and why are they important?

To thrive as a Full Time Prior Authorization RN, you need a strong nursing background (active RN license), in-depth knowledge of medical terminology, and experience with insurance processes or utilization review. Familiarity with prior authorization software, electronic health records (EHRs), and insurance payer portals is typically required. Exceptional attention to detail, critical thinking, and strong communication skills help you effectively evaluate medical necessity and advocate for patient care. These abilities ensure timely, accurate authorizations, reduce claim denials, and promote optimal patient outcomes.

What is the difference between Full Time Prior Authorization Rn vs Medical Coder?

AspectFull Time Prior Authorization RnMedical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), knowledge of medical coding systems
Work EnvironmentHealthcare facilities, insurance companies, utilization review departmentsMedical offices, hospitals, insurance companies, coding agencies
Job FocusReviewing and authorizing medical procedures and treatmentsTranslating medical records into standardized codes for billing

While both roles require healthcare knowledge, the Full Time Prior Authorization RN focuses on evaluating medical necessity for treatments, whereas Medical Coders translate medical documentation into codes for billing. Both are essential in healthcare administration but serve different functions within the patient care and billing process.

What are the most commonly searched types of Prior Authorization Rn jobs in Florida?

The most popular types of Prior Authorization Rn jobs in Florida are:

What cities in Florida are hiring for Full Time Prior Authorization Rn jobs?

Cities in Florida with the most Full Time Prior Authorization Rn job openings:

Full Time Prior Authorization Rn jobs near you

Prior Authorization Specialist

Florida Neurology Group PL

Fort Myers, FL • On-site

$15.75 - $21/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Job description

Description:

Florida Neurology Group has openings for full-time Prior-Authorization Specialists working on pre certifications for infusions/Botox. This position includes verification of insurance benefits as it applies to the pre-certification process, obtaining pre-certification and pre-authorization from payers, and counseling patients regarding their financial obligation with regard to the testing/treatment being scheduled, etc.

RESPONSIBILITIES:

  • Collects and reviews all patient insurance information and submits prior-authorization form.
  • Authorization Specialist are responsible for all aspects of benefit verification and authorization
  • Authorization Specialist ensures that FNG meets patient's insurance requirements for reimbursement prior to testing or treatment.
  • Obtains necessary pre-authorizations from payer.
  • Communicate with physician/clinical staff any pre-certification or PA requirements by the patient's insurance carriers.
  • Ensures up-to-date documentation on patient's account in Electronic Medical
  • Record related to authorization approvals and denials.
  • Works with specialty pharmacies as required by patient's insurance carrier to set up order and delivery of medication.
  • Maintains updated referrals and authorizations.
  • Communicates with ordering physician and/ or APP in the case of denials that will require rescheduling and/or peer-to-peer review by the ordering physician.
  • Contacts patient to notify of termed insurances.
  • Follows policy and procedures outlined by management to ensure standardization of processes across the clinics.

KNOWLEDGE, SKILL AND EXPERIENCE

  • Previous experience in pre-authorization/pre-certification and processing of health insurance claims
  • Knowledge of insurance and third-party payers
  • Previous experience with CPT and ICD-10 coding
  • Basic computer knowledge and keyboarding skills
  • Medical terminology
  • Excellent communication skills
  • Customer service experience
  • Strong organizational skills
  • Detail-oriented
  • Ability to multi-task and work well in a fast-paced setting
  • Critical thinking skills and decisive judgment
  • EMR/ EPIC

Benefits:

  • 401 (k)
  • Dental insurance
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Vision insurance
Requirements: