Medical Insurance Authorization & Claims Specialist

Overview

We are seeking a highly organized, proactive, and detail-oriented Medical Insurance Authorization & Claims Specialist to join a growing healthcare team. This individual will play a key role in ensuring smooth insurance authorization, eligibility verification, claims submission, denial management, and reimbursement follow-up.

The ideal candidate has prior experience in a medical office or healthcare billing setting, understands payer requirements, and can navigate insurance processes efficiently while maintaining a high level of professionalism and accuracy.

This is an excellent opportunity for someone who thrives in a fast-paced medical environment and is committed to supporting both patient care and practice operations.

Responsibilities

• Obtain prior authorizations for office visits, procedures, diagnostic testing, imaging, medications, and treatments
• Verify patient insurance eligibility, benefits, and coverage details
• Submit and track insurance claims accurately and in a timely manner
• Follow up on unpaid, denied, or underpaid claims
• Work insurance rejections, denials, and appeals
• Communicate with insurance carriers, provider portals, and patients regarding coverage and claim status
• Maintain accurate and organized documentation in the patient chart and billing systems
• Review coding and claim information for accuracy, including CPT, ICD-10, and diagnosis/procedure matching
• Coordinate with front desk, clinical staff, and providers to ensure complete documentation for authorization and claims processing
• Stay current with payer guidelines, authorization requirements, and insurance policy changes
• Ensure all work is performed in compliance with HIPAA and office policies

Qualifications

• Minimum 1–2 years of experience in a medical office, billing, or insurance authorization role
• Strong knowledge of:
• Prior authorizations
• Insurance verification
• Claims processing
• Denials and appeals
• CPT and ICD-10 coding
• Familiarity with commercial insurance, Medicare, Medicaid, and managed care plans
• Excellent organizational skills and attention to detail
• Strong verbal and written communication skills
• Ability to multitask and manage high claim/authorization volume
• Experience with EMR/EHR and billing platforms preferred
• GI, specialty office, or procedure-based practice experience is a plus

Preferred Skills

• Experience with:
• Endoscopy / GI procedure authorizations
• Imaging and lab authorizations
• Medication prior authorizations
• Ability to identify trends in denials and resolve issues proactively
• Comfortable working independently and as part of a team

Job Type

Full-time

Pay: $24.00 - $30.21 per hour

Benefits:

• 401(k)
• Flexible schedule

Experience:

• insurance/ claims: 2 years (Preferred)

Work Location: In person