Central Authorization Specialist

Responsibilities

• Educates staff on authorization processes
• Maintains authorization quality
• Identifies and implements workflow and process improvements
• Analyzes denial and billing feedback
• Promotes standardized authorization practices

Requirements

• High school diploma or equivalent
• 3–5 years of related experience and/or training
• At least 2 years of healthcare insurance verification and/or medical billing experience
• About 2–3 years of progressively responsible administrative experience
• Strong computer proficiency
• Knowledge of medical coding and clinical terminology
• Experience obtaining insurance authorizations for patient treatment plans
• Ability to interpret RN and physician documentation to secure authorizations
• Ability to identify and communicate authorization requirements or barriers to clinical staff
• Ability to interpret insurance records and related documentation
• Strong organizational and time management skills with the ability to prioritize multiple responsibilities
• Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and families
• Excellent verbal and written communication skills
• Strong analytical, data management, interpersonal, and negotiation skills
• Able to collaborate effectively with clinicians, finance personnel, and all levels of management

Qualifications

• Preferred: Additional coursework in business, computer science, or healthcare administration
• Experience in a medical or surgical specialty clinic
• Working knowledge of hospital operations, utilization management, case management, and managed care reimbursement
• General understanding of the healthcare revenue cycle, including billing, coding, charge capture, and reimbursement