Insurance Authorization Specialist

Duties & Responsibilities

• Facilitate prior authorization for a variety of services (surgery, injections, medications, imaging, etc.) in a timely manner.
• Work efficiently to facilitate a final approval.
• Ensure all pertinent medical documentation is accurate and complete prior to authorization submission.
• Coverage coordination with workers' compensation case managers to streamline authorizations for care.
• Track and monitor prior authorization status throughout the insurance approval process.
• Utilize a thorough working knowledge of insurance plans and medical policies to complete prior authorization requirements.
• Coordinate with clinical staff during the prior authorization process to include notification of prior authorization approvals and denials in addition to facilitating appeals and peer-to-peer reviews with the payer.
• Works directly with the Director of Billing to identify trends in denials and opportunities for improvement in the authorization process.
• Provide superior customer service when communicating with patients to resolve all inquiries regarding insurance authorization requirements.

Skills/Qualifications/Behaviors

• Bachelor's degree in business or related field
• 1-3 years of billing or authorization experience in the healthcare industry
• Familiarity in navigating the appeals process with insurances and external agencies
• Solution-oriented problem solver, helpful, and strong organizational skills
• Strong multitasking ability; detail oriented
• Proficient with oral and written communication, articulate, professional, and friendly