Authorization Specialist

Job Description Summary

Submits accurate and timely authorization requests to ensure proper reimbursement for patient services. This role involves setting up patient accounts, obtaining necessary clinical documentation, and verifying medical necessity. The specialist must have a solid understanding of basic medical coding, diagnosis codes, and medical terminology. Strong attention to detail, organizational skills, and the ability to work collaboratively with healthcare providers and payers are essential for success in this role.

Job Responsibilities

• Submit accurate and timely authorization requests to insurance companies and payers
• Ensure proper setup and maintenance of patient accounts in the system
• Obtain and review clinical documentation to verify medical necessity
• Communicate with healthcare providers to gather required information for authorizations
• Verify insurance benefits and eligibility for services
• Monitor the status of authorization requests and follow up as needed
• Ensure compliance with payer requirements and regulations
• Utilize basic medical coding, diagnosis codes, and medical terminology in the authorization process
• Maintain detailed records and documentation for all authorizations
• Collaborate with billing and claims teams to resolve any authorization-related issues

Supervisory Responsibilities

This position does not have supervisory responsibilities (i.e., hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.).

Basic Education and/or Experience Requirements

High school diploma or equivalent is required.

Basic Qualifications

• Ability to multi-task and support numerous referrals/priorities at one time
• Ability to work in a fast-paced environment
• High degree of self-discipline in maintaining productivity expectations
• Must be detail-oriented and have a high degree of quality focus

Preferred Qualifications & Interests

Healthcare/medical billing experience preferred.

Pay

The full range for the position is $18.72–$31.20. Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.

Benefits

• Medical, Dental, & Vision Insurance
• Paid Time Off
• Bonding Time Off
• 401K Retirement Savings Plan with Company Match
• HSA Company Match
• Flexible Spending Accounts
• Tuition Reimbursement
• myFlexPay
• Family Support
• Mental Health Services
• Company Paid Life Insurance
• Award/Recognition Programs