Authorization Specialist

Job Description

The Authorization and Benefits Specialist is responsible for the full lifecycle of insurance verification and authorization. This role ensures financial reimbursement by securing pre-authorizations, obtaining retroactive approvals, and maintaining active authorizations for ongoing care. The Specialist serves as a liaison between the organization, third-party payors, and clinical staff to prioritize efficiency.

• Authorization Management: Initiate and secure initial benefits, pre-authorizations, and re-authorizations via payor portals, fax, or telephone.

• Follow-Up & Tracking: Strictly adhere to follow-up schedules (e.g., 3, 7, 14, 30 days) based on payor guidelines to expedite claims and prevent revenue loss.

• Complex Case Resolution: Manage high-complexity requests, including retroactive authorizations and Single Case Agreements (SCAs) for out-of-network patients.

• Data Integrity: Verify that authorization quantities, CPT codes, and effective dates are accurately entered into the practice management system.

• Clinical
  
  Collaboration:
  
  Coordinate directly with healthcare providers to secure necessary clinical notes, letters of medical necessity, and supporting documentation in a timely manner.

• Process Improvement: Develop and maintain a centralized "Payor Master List" and internal authorization manuals to standardize workflows and improve efficiency.

• Compliance: Review and interpret insurance group pre-certification requirements to ensure full compliance before services are rendered.

• Education: Associate’s or Bachelor's degree in Healthcare Administration or related field preferred.

• Experience: Minimum of 2 years of experience in insurance verification, medical billing, or authorization management.

• Technical
  
  Skills:
  
  Proficiency with electronic medical records (EMR) systems, and payor portals.

• Soft Skills: Strong written and verbal communication skills with the ability to build rapport with insurance representatives. Excellent organizational skills and attention to detail.

• Generous benefit Package:
  Medical, Dental, Vision, and Disability
• Company Paid
  - Life Insurance
• 401K with company match
• Company Paid Short-Term Disability
• HSA and FSA options
• Employee Assistance Program
• Employee Recognition