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 approvals for services, and keeping records accurate so care and billing can move forward without unnecessary delays. The ideal candidate brings strong payer knowledge, clear communication skills, and the ability to manage multiple cases in a fast-paced medical setting. Must have experience with EPIC software.
Responsibilities:
- Confirm active insurance coverage, plan benefits, and service eligibility before scheduled visits, procedures, or treatment.
- Secure prior approvals and pre-certifications from health plans for ordered services and document outcomes promptly.
- Audit patient accounts to ensure insurance details are complete, current, and aligned with billing requirements.
- Communicate with patients, clinical staff, providers, and payers regarding coverage status, authorization progress, and expected financial responsibility.
- Track outstanding, denied, or incomplete authorization requests and take follow-up action to reach resolution within required timeframes.
- Maintain precise documentation in the electronic medical record and related billing platforms to support clean claims and reimbursement.
- Investigate insurance-related barriers that could interrupt care delivery or delay payment, and work toward timely correction.
- Follow payer policies, organizational procedures, and applicable regulations while supporting efficient revenue cycle operations.
- Partner with front office, billing, and clinical teams to improve coordination around patient access and authorization workflows.
- At least 3 years of experience in insurance follow-up, authorization, or medical insurance verification within a healthcare setting.
- Working knowledge of prior authorization, preauthorization, medical billing, and patient accounting processes.
- Experience handling authorization forms and communicating with insurance carriers on HMO and PPO plans.
- Ability to review coverage details, benefits, and account information with a high level of accuracy and attention to detail.
- Strong verbal and written communication skills for interacting with patients, providers, and payer representatives.
- Proficiency with electronic medical records and billing systems used to document insurance and authorization activity.
- Ability to manage a high-volume workload, organize priorities effectively, and meet time-sensitive deadlines.