Insurance Authorization Specialist

Position Summary

The Insurance Authorization Specialist is responsible for obtaining timely and accurate insurance authorizations to support uninterrupted client care and ensure reimbursement for services provided by MAC Midwest. This position serves as a subject matter expert on payer authorization requirements and is accountable for proactively managing the authorization process from initial verification through final approval. The Specialist partners closely with Clinical Services, Scheduling, Revenue Cycle, Credentialing, and payer representatives to ensure authorizations are secured before services whenever possible, documentation is complete, and authorization information is accurately entered into organizational systems. This role plays a critical part in minimizing denials, preventing revenue loss, and supporting exceptional client service.

Key Responsibilities

• Insurance Authorization Management

• Manage assigned authorization work queues from initial request through final determination.
• Verify insurance eligibility, benefits, authorization requirements, and medical necessity criteria.
• Submit complete and accurate authorization requests with supporting clinical documentation.
• Proactively monitor pending authorizations and follow up with payers to minimize delays.
• Track authorization expiration dates and coordinate renewals before services lapse.
• Escalate issues that may delay care or reimbursement.

• Revenue Protection

• Ensure authorizations are obtained accurately and timely to maximize reimbursement and reduce preventable denials.
• Partner with Revenue Cycle to resolve authorization-related billing issues.
• Verify approved units, service dates, authorization numbers, and payer information are accurately entered.
• Identify trends contributing to denials and recommend process improvements.

• Documentation & Collaboration

• Maintain complete and accurate documentation within the EHR and payer portals.
• Partner with clinicians, scheduling, and revenue cycle staff to support timely services and billing.
• Communicate authorization status, denials, and required follow-up to internal stakeholders.
• Support audits and maintain compliance with payer and HIPAA requirements.

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.

• Two or more years of prior authorization experience in a healthcare setting required.

• Experience with commercial insurance, Medicaid, and managed care preferred.

• Experience with electronic health records and healthcare billing or revenue cycle processes preferred.

• Proficiency with Microsoft Office and electronic health record systems.

• Strong knowledge of medical terminology and insurance authorization processes.

• Excellent organizational, follow-up, and problem-solving skills.

• Exceptional attention to detail and data accuracy.

• Strong written and verbal communication skills.

• Ability to manage multiple priorities and deadlines.

PHYSICAL DEMANDS

• Prolonged periods of sitting at a desk.
• Moderate use of computer, keyboard and mouse.
• Bend to file or retrieve documents.
• Occasional light physical effort required.
• Ability to lift and carry up to approximately 15 pounds.