Insurance Authorization Specialist

Insurance Authorization Specialist

Position Summary
The Insurance Authorization Specialist is responsible for verifying patient benefits and eligibility, obtaining all necessary pre-authorizations and pre-certifications for scheduled procedures, and ensuring compliance with insurance requirements. This role works closely with carriers and internal teams to manage authorization appeals, resolve rejected claims, and communicate with patients, schedulers, and the billing department regarding any non-authorized services.

Key Responsibilities

• Obtain pre-authorization for all procedures and treatments prior to patient appointments.
• Verify patient eligibility and benefit information before scheduling or performing procedures.
• Investigate and analyze CPT codes not initially noted during the pre-authorization process.
• Review and resolve authorization issues promptly and effectively.
• Communicate authorization status, financial responsibilities, and benefit coverage to patients and providers professionally.
• Collect and maintain documentation supporting authorization approvals or denials.
• Notify management of payer trends to minimize recurring issues.
• Schedule and coordinate Peer-to-Peer conferences and appeals as needed.
• Research and resolve incomplete authorizations.

Qualifications

• Required - High School Diploma or Equivalent
• Preferred - 3-5 years of comprehensive Insurance authorization experience.
• Preferred - Bilingual
• Required - Knowledge of Microsoft applications.
• Required-Knowledge of CPT and ICD-10.

Job Type: Full-time

Pay: From $18.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Insurance authorization: 3 years (Required)
• Peer to Peer set up: 1 year (Required)
• Pre Determination: 2 years (Required)

Language:

• Spanish (Preferred)

Work Location: In person