Authorization Specialist

Job Description

We are looking for an experienced Authorization Specialist to join our team. This position will manage the prior authorization and approval process to provide timely orthotic and prosthetic services to our patients across western Pennsylvania. This position will be fully remote after initial training period.

**Will discuss the hourly rate during the hiring process**

Responsibilities:

• Review patient data for accuracy on cases submitted for approval
• Confirm insurance eligibility and patient financial responsibility
• Obtain required documentation from referrals
• Review and interpret medical records and apply payor criteria to confirm medical necessity
• Ensure accurate coding using ICD10 and HCPCS
• Process cases timely to avoid treatment delays and reduce administrative burden
• Submit demographic and clinical data to payors for approval as required
• Collaborate with internal teams and payors to ensure compliance and seamless coordination
• Communicate with patients regarding coverage and any financial responsibility
• Schedule delivery appointments when necessary
• Ensures insurance carrier documentation requirements are met and referral support documentation is charted in patient's medical record
• Stay abreast of continual changes in the health insurance coverage guidelines
• Maintain documentation of activities within a patients file
• Effectively manage excellent correspondence with patients, physicians, specialists, and insurance companies
• Maintains HIPAA compliance practices at all times

Qualifications

• Strong attention to detail, accuracy, and ability to multitask
• Excellent customer service and phone skills
• Demonstrated success and familiarity with tools, technology, and systems including computer skills, spreadsheets, word processing, patient records systems, EMR systems, etc.
• Work in coordination with medical providers regarding issues in documentation, diagnoses, etc regarding patient’s approval for our services
• Efficiently manages correspondence with patients, referral, and insurance companies
• Ability to work with a team as well as independently

Schedule:

• 40 hours/week (4-day workweek option available)
• Training: Approximately 1 month training onsite (location TBD)
• Post-training: Fully remote

Benefits:

• 401(k)
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Remote