Medical Insurance Authorization Specialist

We are seeking a detail-oriented and organized Medical Insurance Verification Specialist / Authorization Specialist to join our healthcare team. In this role, the Medical Insurance Verification Specialist / Authorization Specialist will verifying patient insurance coverage, obtaining prior authorizations, and ensuring accurate documentation to support timely billing and reimbursement. The ideal candidate has strong knowledge of insurance verification and authorization processes, excellent communication skills, and the ability to work efficiently in a fast-paced medical environment.

Key Responsibilities:

• Verify patient insurance eligibility, benefits, and coverage prior to appointments, procedures, or treatment.
• Obtain prior authorizations and pre-certifications from insurance carriers for medical services and procedures.
• Review patient accounts for accuracy and completeness of insurance information.
• Communicate with patients, providers, and insurance companies regarding authorization status, coverage details, and financial responsibility.
• Follow up on pending, denied, or incomplete authorizations to ensure timely resolution. .
• Maintain accurate and up-to-date records in the electronic medical record (EMR) and billing systems. Based on general knowledge.
• Identify and resolve insurance-related issues that may delay patient care or reimbursement.
• Ensure compliance with payer guidelines, internal procedures, and regulatory requirements.
• Collaborate with front office, billing, and clinical teams to support smooth patient access and revenue cycle operations.

This roles is remote in the CST/EST time zone. All equipment will be provided.

• At least 3 years of experience in insurance verification, authorization, insurance follow-up, or a related healthcare revenue cycle role.
• Working knowledge of prior authorization, pre-certification, and medical insurance verification processes.
• Experience supporting medical billing and patient accounting functions in a healthcare setting.
• Familiarity with HMO and PPO plans, including benefit review and coverage interpretation.
• Ability to complete and manage authorization forms accurately and efficiently.
• Strong verbal and written communication skills for interacting with patients, providers, and insurance representatives.
• High attention to detail with the ability to manage multiple priorities in a fast-paced environment.