Pre Service IV Auth Specialist

Our client operates within the healthcare sector, serving patients across the Pacific Northwest. With more than 140 years of experience, it focuses on improving patient access and coordinating healthcare services through comprehensive support, authorization, and financial clearance processes. The organization partners with patients, families, providers, and communities to facilitate efficient and accessible care.

About the Role

The Pre-Service IV/Auth Specialist plays a critical role in securing timely and accurate pre-authorizations and financial clearance for healthcare services. This position verifies insurance eligibility, processes authorization requests, reviews supporting documentation, and communicates with providers and insurance carriers to prevent delays in patient care. The role also serves as a resource for referral, authorization, and insurance plan requirements while supporting accurate registration and financial processes.

Responsibilities

• Secure pre-authorizations for office visits, procedures, imaging studies, therapy sessions, and other healthcare services.
• Respond to clinical inquiries through insurance portals to facilitate authorization approvals.
• Review medical records and supporting documentation to ensure accurate authorization submissions.
• Process medical authorization requests efficiently to minimize delays in patient care.
• Communicate with healthcare providers, insurance carriers, and patients to obtain required information.
• Meet daily productivity standards and maintain efficient authorization workflows.
• Perform registration activities, including insurance data entry and eligibility verification.
• Maintain accurate insurance and patient information to minimize claim denials and support financial clearance.
• Serve as a subject matter resource for referrals, authorizations, and insurance guidelines within the health system.

Requirements

• Minimum of 2 years of experience in pre-authorization, referral coordination, insurance billing, admitting, registration, or a related healthcare role.
• Experience providing customer service in a healthcare environment.
• Proficiency with medical terminology.
• Ability to review medical policies and interpret CPT and HCPCS codes according to payer guidelines.
• Strong attention to detail and accuracy when reviewing patient and insurance information.
• Preferred: Completion of a health vocational program, such as Medical Assistant or Medical Billing & Insurance.
• Preferred: One year of post-secondary business or college coursework.
• Preferred: Certification from the National Association of Healthcare Access Management (NAHAM).

Pay

Hourly pay range of $19.51–$28.08, with final compensation based on skills, experience, certifications, education, and other relevant factors.

Benefits

• Medical insurance.
• Dental insurance.
• Retirement benefits, including 401(k).
• Paid time off.