We are looking for a dedicated Pre-Authorization Specialist to join our team in Miramar, Florida. In this contract-to-hire position, you will play a key role in coordinating insurance authorizations and ensuring accurate patient documentation for medical equipment delivery. This role requires exceptional organizational skills and a strong understanding of insurance policies and billing processes. Responsibilities:• Review clinical denials, including cases related to referrals, pre-authorizations, medical necessity, and non-covered services.• Prepare and submit medical necessity determinations to health plans or medical directors by analyzing clinical documentation in adherence to Medicare, Medicaid, and third-party payer guidelines.• Maintain and update referral information while tracking changes in patient status.• Verify patient eligibility and ensure insurance benefits are appropriately identified.• Coordinate callbacks to patients regarding inquiries and provide clear guidance.• Ensure all required documentation, such as prescriptions and physician notes, is obtained prior to medical equipment delivery.• Determine delivery methods for medical equipment, including direct delivery to homes, physician offices, hospitals, or the company office.• Track inventory of medical equipment and oversee shipping processes.• Collaborate closely with nursing coordinators and instructors to support patient needs.• Assist with general office operations to ensure smooth workflows.

• At least 2 years of experience in insurance and billing processes. • Proficiency in managing and appealing insurance denials. • Comprehensive knowledge of Medicare, Medicaid, and third-party payer regulations. • Familiarity with insurance intake processes, including verification, preauthorization, benefit identification, billing, and collections. • Understanding of medical insurance terminology, coding structures, and billing forms such as the CMS-1500. • Experience working with home medical equipment is preferred. • Strong organizational skills, attention to detail, and a fast-learning ability. • Ability to handle administrative tasks such as calendar management, scheduling, and answering inbound calls.

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Miramar, FL
onsite
Temporary
18.00 - 20.00 USD / Hourly
We are looking for a dedicated Pre-Authorization Specialist to join our team in Miramar, Florida. In this contract-to-hire position, you will play a key role in coordinating insurance authorizations and ensuring accurate patient documentation for medical equipment delivery. This role requires exceptional organizational skills and a strong understanding of insurance policies and billing processes. Responsibilities:• Review clinical denials, including cases related to referrals, pre-authorizations, medical necessity, and non-covered services.• Prepare and submit medical necessity determinations to health plans or medical directors by analyzing clinical documentation in adherence to Medicare, Medicaid, and third-party payer guidelines.• Maintain and update referral information while tracking changes in patient status.• Verify patient eligibility and ensure insurance benefits are appropriately identified.• Coordinate callbacks to patients regarding inquiries and provide clear guidance.• Ensure all required documentation, such as prescriptions and physician notes, is obtained prior to medical equipment delivery.• Determine delivery methods for medical equipment, including direct delivery to homes, physician offices, hospitals, or the company office.• Track inventory of medical equipment and oversee shipping processes.• Collaborate closely with nursing coordinators and instructors to support patient needs.• Assist with general office operations to ensure smooth workflows.
2025-09-26T19:18:47Z

Pre-authorization Specialist Job in Miramar | Robert Half