Medical Authorization Specialist

We are seeking Medical Authorization Specialist to focus on verifying insurance eligibility
, managing prior/pre-authorization requests
, and ensuring accurate medical billing
. The specialist will calculate revenue and allowable amounts
, submit compliant billing to government and private insurance payers
, and coordinate with the Sales Team to collect required documentation before invoicing. The role requires strong knowledge of insurance guidelines, coordination of benefits, and healthcare compliance
.

• Verify insurance eligibility and follow coordination of benefits (COB) guidelines to ensure accurate coverage determination.
• Prepare and fax accurate Pre-Authorization Request Letters
  , ensuring completeness and compliance with payer requirements.
• Determine revenue amounts based on allowable charges, benefits, unit pricing, payer guidelines, copayments, and contract pricing
  .
• Submit accurate billing to Government entities and private insurance payers in compliance with Federal, State, and insurance-specific regulations
  .
• Obtain and track supporting documentation from the Sales Team to ensure all required documents are received prior to invoicing
  .
• Maintain compliance with healthcare billing standards while ensuring accuracy, timeliness, and documentation integrity.

• Insurance Eligibility Verification
  .
• Pre-Authorization / Prior Authorization
  .
• Coordination of Benefits (COB).
• Medical Billing & Revenue Calculation
  .
• Government and Commercial Payer Billing
  .
• HIPAA, Federal and State Compliance
  .
• Documentation Management & Invoicing Support
  .

Brick Red Systems is a global leader in next-generation technology, consulting, and business process service companies. We enable clients to navigate their digital transformation. Brick Red Systems delivers a range of consulting services to our clients across multiple industries around the world. Our practices employ highly skilled and experienced individuals with a client-centric passion for innovation and delivery excellence. With ISO 27001 and ISO 9001 certification and over a decade of experience in managing the systems and workings of global enterprises, we harness the power of cognitive computing hyper-automation, robotics, cloud, analytics, and emerging technologies to help our clients adapt to the digital world and make them successful.

Our always-on learning agenda drives their continuous improvement through building and transferring digital skills, expertise, and ideas from our innovation ecosystem.