Authorization Specialist - TGMG Phy Practice Plan

About the role

The Authorization Specialist is responsible for coordinating and securing insurance pre-certifications and pre-authorizations for medical procedures, outpatient testing, and prescribed medications. This role serves as a liaison between providers, insurance carriers, patients, and external agencies to ensure timely access to care while maintaining complete and accurate documentation within the electronic medical record (EMR).

Responsibilities

• Serves as a liaison between providers, insurance carriers, patients, and external agencies to ensure timely access to care while maintaining complete and accurate documentation within the electronic medical record (EMR).
• Supports continuity of care by facilitating appointments, triaging patient communications, and assisting with peer-to-peer reviews to resolve authorization barriers efficiently.
• Accurately documents clinical, insurance, and authorization details in an electronic medical record to ensure compliance and continuity of care.
• Educates and guides patients through complex authorization processes while delivering a positive, supportive patient experience.
• Manages multiple authorizations, appointments, and deadlines simultaneously in a fast-paced clinical environment.
• Gathers medical necessity documentation, identifies authorization barriers, and supports peer-to-peer review coordination for timely resolution.

Requirements

• High School diploma or GED
• Six (6) months’ medical office experience to include auth/pre-cert.
• Knowledge of medical terminology, CPT & ICD-9 coding.
• Excellent communication skills
• Understanding of pre-certification, prior authorization, and referral requirements across various payer types, including commercial, Medicare, and Medicaid plans.
• Ability to accurately document clinical, insurance, and authorization details in an electronic medical record to ensure compliance and continuity of care.
• Strong written and verbal communication skills to interact effectively with physicians, insurance carriers, patients, and external healthcare organizations.
• Ability to manage multiple authorizations, appointments, and deadlines simultaneously in a fast-paced clinical environment.
• Ability to gather medical necessity documentation, identify authorization barriers, and support peer-to-peer review coordination for timely resolution.

Qualifications

• High School diploma or GED
• Six (6) months’ medical office experience to include auth/pre-cert.
• Knowledge of medical terminology, CPT & ICD-9 coding.
• Excellent communication skills
• Understanding of pre-certification, prior authorization, and referral requirements across various payer types, including commercial, Medicare, and Medicaid plans.
• Ability to accurately document clinical, insurance, and authorization details in an electronic medical record to ensure compliance and continuity of care.
• Strong written and verbal communication skills to interact effectively with physicians, insurance carriers, patients, and external healthcare organizations.
• Ability to manage multiple authorizations, appointments, and deadlines simultaneously in a fast-paced clinical environment.
• Ability to gather medical necessity documentation, identify authorization barriers, and support peer-to-peer review coordination for timely resolution.

Skills

• Understanding of pre-certification, prior authorization, and referral requirements across various payer types, including commercial, Medicare, and Medicaid plans.
• Ability to accurately document clinical, insurance, and authorization details in an electronic medical record to ensure compliance and continuity of care.
• Strong written and verbal communication skills to interact effectively with physicians, insurance carriers, patients, and external healthcare organizations.
• Ability to educate and guide patients through complex authorization processes while delivering a positive, supportive patient experience.
• Ability to manage multiple authorizations, appointments, and deadlines simultaneously in a fast-paced clinical environment.
• Ability to gather medical necessity documentation, identify authorization barriers, and support peer-to-peer review coordination for timely resolution.

Benefits

• Hybrid remote work option
• Full-time schedule
• Flexible work hours: 8am-5pm

Pay

$35,110.40 per year

Schedule

Full-time