Authorization Specialist

About the role

Remote position available to candidates residing in AL, FL, GA, IL, IN, MI, MO, NC, OH, PA, SC, TN, TX, or VA.

We are seeking a detail-oriented and organized Authorization Specialist to join our team remotely. In this role, you will oversee verification and authorization processes to ensure accuracy, compliance, and timely approvals across departments.

Responsibilities

Primary Duties — Authorization & PCP Referrals

• Obtain authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed, staying a minimum of seven days ahead of scheduled service, and ensuring that authorization, referral, or pre-determination is obtained for add-on appointments in advance or on the same day of service.
• Obtain vision plan authorizations.
• Obtain PCP referrals for HMOs and provide feedback to supervisors on any particularly difficult or time-consuming PCP offices.
• Obtain prior authorization or pre-determination as needed for clinic and facility services.
• Obtain prior authorization for procedures as required by insurance plans.
• Review MDI Pending notifications for imaging orders and obtain prior authorization for those which need approval.
• Coordinate patients’ assistance applications for specific procedures when applicable, to include financing options for patients.
• Document authorization, referral, pre-determination activities in NextGen.

Secondary Duties — Eligibility Verification

• Verify eligibility as active staying a minimum of a week ahead of scheduled service.
• Verify eligibility as active for add-on appointments, staying ahead of schedule and verifying eligibility the same day for services scheduled and performed on the same day.
• Use NextGen to identify and correct inactive or incorrectly registered policies and addresses.
• Utilize payer websites for further verification when needed.
• Contact patients to update/obtain correct information when needed.
• Validate that the correct plan was chosen per the insurance guide and provide feedback to supervisor for feedback to upstream areas.
• Confirm network participation and advise patient of our provider’s network participation when needed.
• Forward new plans to supervisor for payer file updates.
• Document verification activities in NextGen to support productivity and quality tracking.
• Ensure NextGen system is updated.

Other Duties

• During non-peak times, provide additional RCM support within other departments (e.g., patient assistance — enrollments, shipments, and replacement drugs), A/R support (claim status for unresponded-to claims, review and outreach to patients with large outstanding balances and accounts in pre-list status, targeted denial management).

Requirements

Competencies

• Proven experience in verification, authorization, or related administrative roles.
• Strong attention to detail and organizational skills.
• Excellent written and verbal communication with a compassionate, patient-centered approach.
• Ability to work independently in a remote environment and manage multiple priorities.
• Proficiency with EHR and billing platforms (e.g., NextGen and Intellichart Pro).
• Exceptional attention to detail, organization, and multitasking ability in a fast-paced environment.

Education & Experience

• High school graduate or equivalent.
• Customer service and healthcare experience.
• Proficient in computer and typing.
• Knowledge of Microsoft Office products (Word, Excel).
• Excellent customer service skills via phone, in person, or email.
• Ability to manage multiple, ongoing tasks while maintaining professional composure.
• Understanding of insurance and medical terminology.

Physical Demands

• Prolonged periods of sitting at a desk and working on a computer.
• Noise level in the work environment is usually moderate.
• Moderate lifting 10–50 lbs.
• Hybrid role — ability to travel between locations as necessary.

Schedule

Full-time position. Days and hours are Monday through Friday, 8:00 A.M. – 5:00 P.M., with occasional overtime.

Benefits

• 401(k) Company Match
• Medical and Dental Insurance
• Vision Benefits
• Paid Parental Leave
• Flexible Spending Accounts
• Disability Insurance
• Life Insurance
• Paid Time Off