Overview

Authorization / Referral / Insurance Benefits Specialist Jobs in Boca Raton, FL at Rothenberg Orthopedics, Regenerative and Sports Medicine

Rothenberg Orthopedics is seeking an experienced, highly organized, and proactive Authorization / Referral / Insurance Benefits Specialist to join our fast-paced orthopedic and regenerative medicine practice in Boca Raton, Florida.

This role is critical to ensuring seamless patient care, financial clearance, and insurance compliance across orthopedic, regenerative, diagnostic imaging, and procedural services. The ideal candidate thrives in a high-volume specialty practice, possesses strong payer knowledge, communicates professionally with patients and insurance carriers, and takes ownership of the authorization process from submission through resolution.

CORE RESPONSIBILITIES – Insurance Authorization & Pre-Certification

  • Obtain all required pre-authorizations, pre-certifications, and pre-determinations for orthopedic, regenerative medicine, diagnostic, and procedural services prior to the date of service.
  • Verify medical necessity criteria specific to each payer and accurately submit supporting clinical documentation, including provider notes, imaging reports, and conservative-care histories.
  • Manage authorizations for advanced imaging (MRI, CT, ultrasound, X-ray), shockwave therapy, laser therapy, PRP and stem cell procedures, joint injections, durable medical equipment (DME), and surgical procedures.
  • Track authorization expiration dates and proactively renew or extend approvals before services lapse.
  • Submit appeals for denied authorizations, including peer-to-peer review coordination with the physician when required.
  • Maintain an organized authorization tracking log within ECW (eClinicalWorks) and any supplemental tracking tools used by the practice.
  • Confirm CPT and ICD-10 coding accuracy on every authorization request to prevent denials due to coding mismatches.

Insurance Verification & Patient Financial Clearance

  • Verify active insurance eligibility, benefits, copays, deductibles, and out-of-pocket maximums for every patient prior to service.
  • Identify in-network vs. out-of-network status for each payer and communicate financial responsibility to patients in advance.
  • Prepare and document Good Faith Estimates, Advance Beneficiary Notices (ABNs), and patient financial responsibility forms as required.
  • Coordinate with the front desk and billing team to ensure copays and balances are collected at the time of service.
  • Educate patients on coverage limitations, prior authorization status, and any non-covered services so they can make informed decisions.

Payer & Referral Management

  • Maintain working knowledge of authorization requirements for all major commercial payers, Medicare, Medicare Advantage, Medicaid Managed Care, and workers’ compensation carriers active in South Florida.
  • Process incoming referrals from primary care physicians, urgent care centers, and other referring providers; confirm referral validity and authorization linkage.
  • Build and maintain positive working relationships with payer representatives, utilization management nurses, and provider service lines.
  • Stay current on payer policy updates, formulary changes, and coverage criteria revisions; communicate relevant changes to Samantha Himmel and Stephen Rothenberg and clinical staff.
  • Manage workers’ compensation case authorizations, adjuster communication, and case-specific documentation requirements.

Documentation, Compliance & ECW System Use

  • Document every authorization request, approval, denial, and appeal completely and accurately within ECW.
  • Attach authorization numbers, effective dates, expiration dates, and approved units/visits to the appropriate encounter in ECW.
  • Maintain HIPAA compliance in all communications with payers, patients, and external parties.
  • Ensure proper documentation supports medical necessity standards required under Medicare, Medicaid, and commercial payer guidelines.
  • Participate in internal audits of authorization accuracy and completeness; act on corrective feedback promptly.
  • Adhere to all practice policies, HIPAA, OSHA, and applicable federal and state healthcare regulations.

Team Collaboration, Cross-Training & Cross-Department Support

  • Maintain a consistently positive attitude that strengthens team morale and contributes to a respectful, professional workplace.
  • Operate as a true team player — willing to step in, lend a hand, and support colleagues whenever the department needs help.
  • Cross-train with front desk, scheduling, intake, clinical, and billing team members to provide flexible coverage during PTO, illness, or peak volume.
  • Actively support other departments by helping submit and meet patient needs — including authorization-adjacent tasks, referral coordination, intake assistance, and follow-up communication.
  • Train other team members on authorization workflows so that no single point of failure exists in the department.
  • Communicate proactively with management about workload, blockers, and any situations that may impact patient care or revenue.
  • Contribute to a supportive, solution-oriented team culture — bringing ideas.

Patient Communication & Service

  • Communicate authorization status updates to patients with empathy, clarity, and professionalism.
  • Answer patient questions regarding benefits, coverage, and authorization timelines; escalate complex cases when appropriate.
  • Coordinate with the scheduling team to delay or reschedule services that have not received required authorization.
  • Treat every patient interaction as a reflection of the high-end professional brand of Rothenberg Orthopedics.

QUALIFICATIONS & REQUIREMENTS

  • Proficiency in eClinicalWorks (ECW) for authorization documentation, encounter linkage, and patient record management.
  • Working knowledge of CPT, HCPCS, and ICD-10 coding — especially for orthopedic, sports medicine, regenerative, and diagnostic imaging services.
  • Familiarity with payer portals including but not limited to Availity, UnitedHealthcare, Aetna, Cigna, Humana, BCBS, Medicare, and Medicare Advantage carriers.
  • Experience interpreting Explanation of Benefits (EOB) statements, denial codes, and authorization requirement grids.
  • Proficiency in Microsoft Office Suite (Outlook, Excel, Word) and comfort with web-based payer tools and clearinghouse platforms.
  • Strong written and verbal communication skills for payer correspondence, patient communication, and internal documentation.

Core CompetenciesAttitude & Teamwork

  • Positive, can-do attitude — even under deadline pressure or payer pushback.
  • Team player who supports colleagues and contributes to a respectful, collaborative environment.
  • Cross-trains willingly and supports other departments to help meet patient needs.
  • Trains others on authorization workflows — building team depth and resilience.
  • Dependable and reliable — contributes consistently to team coverage and continuity.

Accuracy & Accountability

  • Detail-oriented in coding, documentation, and tracking of authorization status.
  • Takes ownership of every assigned authorization from request through approval or appeal.
  • Proactive in identifying and resolving issues before they impact patient care or practice revenue.
  • Maintains organized records that withstand internal audit and payer review.

Patient & Compliance Focus

  • Communicates with patients with empathy, clarity, and respect for their financial situation.
  • Deeply committed to HIPAA, payer compliance, and ethical billing practices.
  • Treats every patient interaction as a reflection of the Rothenberg Orthopedics brand and reputation.

WORKING CONDITIONS & PHYSICAL REQUIREMENTS

  • Professional clinical office environment in Boca Raton, Florida.
  • Standard clinic hours, Monday–Friday.
  • Frequent communication by phone, fax, secure email, and payer portal with insurance representatives, patients, providers, and internal team members.
  • Collaborative interaction with administration, front desk, scheduling, and clinical teams throughout the workday.

Physical Requirements

  • Ability to sit at a desk and work on a computer for extended periods.
  • Ability to use a telephone headset and computer keyboard for sustained periods.
  • Occasional walking throughout the clinic to coordinate with clinical and front desk staff.
  • Occasional lifting of office supplies or files up to 15 lbs.
  • Strong visual acuity for reviewing clinical documentation, payer portals, and authorization records.
  • Clear verbal and written communication skills for patient, payer, and internal team interaction.

Position Details

  • Full-Time
  • Monday–Friday
  • In-Office Position
  • Competitive compensation based on experience

Pay: $18.00 – $23.00 per hour

Work Location: In person

Title: Authorization / Referral / Insurance Benefits Specialist

Company: Rothenberg Orthopedics, Regenerative and Sports Medicine

Location: Boca Raton, FL

 

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