Archived listing. The details below describe a past opening.
We are looking for an Insurance Authorization Specialist to support patient access and reimbursement activities for a healthcare team. This Insurance Authorization Specialist position focuses on confirming insurance coverage, securing required approvals for services, and maintaining accurate records that help keep care and billing processes on track. The ideal candidate brings strong knowledge of payer guidelines, prior authorization workflows, and medical billing practices, along with the ability to communicate clearly in a fast-paced clinical setting.
Responsibilities:
- Confirm patient eligibility, plan benefits, and coverage details before scheduled visits, treatments, or procedures.
- Secure prior authorizations and pre-certifications from insurance carriers for ordered medical services within required timelines.
- Review patient accounts to ensure insurance data is complete, accurate, and ready for billing follow-up.
- Communicate with patients, clinical staff, providers, and payers regarding approval status, benefit information, and out-of-pocket responsibility.
- Track unresolved, delayed, or denied authorization requests and take appropriate action to obtain timely outcomes.
- Maintain precise documentation in electronic medical records and billing platforms to support reimbursement and audit readiness.
- Investigate insurance-related discrepancies that could interrupt care delivery or delay claim payment, and work toward resolution.
- Follow payer policies, regulatory expectations, and internal standards throughout verification and authorization activities.
- Partner with front office, billing, and care teams to improve patient access and support efficient revenue cycle operations.
- 3+ years of experience in insurance follow-up, medical insurance verification, or authorization support within a healthcare setting.
- Working knowledge of prior authorization, preauthorization, and pre-certification processes across multiple payer types.
- Familiarity with medical billing, patient accounting, and documentation practices tied to reimbursement workflows.
- Experience handling HMO and PPO insurance plans, including benefits review and coverage validation.
- Ability to complete and manage authorization forms with a high level of accuracy and attention to detail.
- Strong verbal and written communication skills for interacting with patients, providers, and insurance representatives.
- Proficiency in maintaining accurate records within electronic medical record and billing systems.
- Ability to manage multiple priorities effectively in a high-volume, fast-paced environment.