MS/Prior Authorization Spec

WHO WE ARE & WHAT WE DO

Tallahassee Memorial HealthCare (TMH) is a private, nonprofit community-based healthcare system that provides advanced care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community. 

 TMH is the region’s healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region’s only:

• Level II Trauma Center
• Primary Stroke Center
• Level III Neonatal Intensive Care
• Pediatric Intensive Care
• The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle.

Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices.

HOW YOU'LL MAKE AN IMPACT

Your Role:

• Manages the prior authorization process for medical procedures, treatments, and medications; uses a proactive approach to ensure prompt approvals and facilitate smooth patient care.
• Manages prior authorizations.
• Maintains documents and records.
• Verifies insurance coverage.
• Collaborates with healthcare providers, physicians, and clinical staff members.
• Audits documents to ensure regulatory compliance.
• Displays an understanding of diversity.
• Demonstrates integrity, compassion, accountability, respect, and excellence (I CARE values).
• Enhances and contributes to a safe environment for all colleagues, visitors, and patients.
• Performs miscellaneous duties.

Reports To: MS [Medicus Select]/Director Operations (JC: 820802).

Supervises: None.

WHAT YOU’LL NEED TO APPLY

Required Education: High school diploma or equivalent (e.g., certificate of high school equivalency).

Preferred Education: Vocational certificate or associate degree in a healthcare, education, information science, or related field. 

Required Experience: Two (2) years of relevant, job-related work experience.

Preferred Experience:

• Two (2) years of experience with Allscripts Practice Management (PM) and Electronic Health Records (EHR) and/or in insurance, billing, and collections. 
• Clinical background or experience in a medical setting. 
• Knowledge of charges, payments, and collections. 
• Knowledge of Allscripts. 
• Ability to multi-task effectively. 
• Very meticulous. 

Required Certification/License/Registry: None.

Preferred Certification/License/Registry: None.

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Tallahassee Memorial HealthCare is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.