insurance verification specialist

Akron Children's

<div></div><div><h2 class="jobSectionHeader"><b>Job Description</b></h2>
<b>Job Requisition Number</b> 31897
<div><div><b>Full-time, 40 Hours/Week</b></div><div><b>
Monday - Friday, Day Shift</b></div><div><b>
Remote (First 90 days onsite)</b></div><div></div><div><b><br>
Summary:</b></div><p><br>
The Authorization Specialist is responsible for obtaining prior authorizations and verifying insurance coverage for pediatric patients. This includes therapy, behavioral health, diagnostic procedures, specialist visits, surgeries, injections, infusion therapies, and advanced radiology services (CT, MRI, PET, and Nuclear Medicine). The specialist plays a critical role in ensuring timely access to care, supporting families in navigating the insurance process, and helping minimize financial barriers to treatment.</p><p></p><div><b>
Responsibilities:</b></div><br>
<p></p><ul><li>
Secure prior authorizations for a variety of pediatric services.</li><li>
Verify insurance eligibility and benefits prior to service; ensure benefits and authorizations are clearly documented in the patient record.</li><li>
Gather, verify, and review the necessary clinical documentation from providers, including medical records, progress notes, lab results, treatment plans, and any other require information to ensure requested services meeting payer medical necessity requirements based on CPT codes provided.</li><li>
Coordinate with clinical and scheduling teams to prevent delays in care caused by pending or denied authorizations.</li><li>
Participate in clinical huddles and team meetings to discuss challenges, share best practices, and contribute to process improvement initiatives.</li><li>
Follow-up with payers to obtain timely approvals and resolve issues related to pediatric-specific criteria (e.g., age-based guidelines, developmental appropriateness).</li><li>
Communicate denied authorizations and next steps to initiate the peer to peer or appeal process, track and manage the outcomes, and escalate any issues.</li><li>
Refer families to Financial Counseling when patient responsibility amounts are identified and provide clear guidance to support caregiver understanding.</li><li>
Maintain accurate records of authorization statuses and payer communications in the EHR.</li><li>
Collaborate with care teams, including case management, to expedite authorizations for urgent services when needed.</li><li>
Meet departmental standards for productivity, accuracy, and timeliness.</li></ul><p></p><div><b>
Other information:</b></div><p><b><br>
Technical Expertise</b></p><p></p><ul><li>
Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits.</li><li>
Strong interpersonal communication skills to support families with empathy and clarity.</li><li>
Ability to navigate multiple systems (EHR, payer portals); Epic experience preferred.</li><li>
Understanding of medical necessity and documentation standards for pediatric services.</li></ul><p></p><p><b>
Education and Experience</b></p><ul><li>
Education: High school diploma or equivalent required; associate degree or healthcare certification preferred.</li><li>
Experience: Minimum 1 year in a Clinical, Revenue Cycle, Patient Access or Insurance company role that perform work related to; prior authorization, insurance verification, billing, scheduling, patient service rep, customer service, etc. required.</li><li>
Pediatric healthcare access roles preferred.</li><li>
Working with pediatric patients, families, or within a children's hospital preferred.</li><li>
Familiarity with pediatric insurance policies, including Medicaid, managed care, and commercial plans preferred.</li></ul><p></p><div>
Full Time</div><div></div><div>
FTE: 1.000000</div></div></div><p></p>

Authorization Specialist

Macrise Tech Solutions

<p>We are looking for a highly organized and detail-focused <b>Insurance Verification &amp; Authorization Specialist</b> to join our medical billing team. This role is essential in ensuring accurate insurance eligibility verification, securing timely prior authorizations, and maintaining complete documentation to support efficient billing and claims processing. The ideal candidate possesses strong communication skills, exceptional attention to detail, and a solid understanding of payer guidelines, with the ability to perform effectively in a fast-paced healthcare environment.</p><p><b>Key ResponsibilitiesInsurance Verification &amp; Eligibility</b></p><ul><li>Verify patient insurance coverage through payer portals and direct communication with insurance carriers.</li><li>Maintain accurate and up-to-date eligibility records within the Electronic Health Record (EHR) system, such as eClinicalWorks.</li><li>Complete, upload, and document insurance verification information promptly for all new patient registrations.</li><li>Clearly communicate estimated patient financial responsibility, including copays, deductibles, and out-of-pocket expenses.</li><li>Escalate unresolved eligibility discrepancies or coverage issues to the Patient Collections team when necessary.</li><li>Proactively follow up with patients to obtain missing, corrected, or updated insurance information.</li></ul><p><b>Authorizations &amp; Regulatory Compliance</b></p><ul><li>Obtain prior authorizations for medical and behavioral health services requiring payer approval.</li><li>Ensure compliance with Medicaid and other payer-specific authorization policies and procedures.</li><li>Collaborate with the Patient Services team to manage out-of-network insurance cases.</li><li>Secure authorizations for psychological assessments while maintaining accurate documentation and system alerts.</li></ul><p><b>Operational Support &amp; Collaboration</b></p><ul><li>Assist with urgent or same-day appointment scheduling when required.</li><li>Monitor and communicate updates related to payer policies, billing issues, and provider network participation.</li><li>Work closely with the Practice Manager to resolve incomplete or inaccurate patient intake documentation.</li><li>Participate in team meetings to improve workflows, enhance data accuracy, and support continuous process improvement initiatives.</li></ul><p>Job Type: Full-time</p><p>Pay: Rs45,000.00 - Rs70,000.00 per month</p><p>Ability to commute/relocate:</p><ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul><p>Application Question(s):</p><ul><li>Willing to work in the USA time?</li></ul><p>Experience:</p><ul><li>Medical Billing: 1 year (Preferred)</li></ul><p>Language:</p><ul><li>English (Required)</li></ul><p>Work Location: In person</p>

Verification of Benefits-Medical Billing

Infinx

<div><p><b>About Our Company:</b><br>
At Infinx, we're a fast-growing company focused on delivering innovative technology solutions to meet our clients' needs. We partner with healthcare providers to leverage automation and intelligence, overcoming revenue cycle challenges and improving reimbursements for patient care. Our clients include physician groups, hospitals, pharmacies, and dental groups.<br>
We're looking for experienced associates and partners with expertise in areas that align with our clients' needs. We value individuals who are passionate about helping others, solving challenges, and improving patient care while maximizing revenue. Diversity and inclusivity are central to our values, fostering a workplace where everyone feels valued and heard.</p><p><b>
A 2025 Great Place to Work</b><b><i>&reg;</i></b></p><p>
In 2025, Infinx was certified as a Great Place to Work<i>&reg;</i> in both the U.S. and India, underscoring our commitment to fostering a high-trust, high-performance workplace culture. This marks the fourth consecutive year that Infinx India has achieved certification and the first time the company has earned recognition in the U.S.</p><b><br>
Location: </b>Remote<br>
<br>
<b>Summary Description:</b><br>
This <b>remote</b> Prior Authorization Specialist supports the Patient Access Onshore department in various functions, insurance verification and coordinating prior authorization requests for medications. This position and is critical in facilitating timely patient access to healthcare by managing prior authorization processes. This role involves contacting payers for benefit information, checking authorization requirements, collecting required documentation, submitting requests to payers, and tracking authorization status.<br>
<br>
<b>Daily Responsibilities:</b><ul><li>
Contacting payers for eligibility and benefit information to include authorization requirements</li><li>
Obtain prior authorizations and pre-certifications</li><li>
Submit complete and accurate authorization requests</li><li>
Follow up and resolve pending authorization requests</li><li>
Maintain documentation of authorization activity</li><li>
Stay current on payer prior authorization requirements</li></ul><b>
Skills and Education:</b><ul><li>
High School Diploma or GED</li><li>
Must be able to work from 8am - 5pm Central</li><li>
2 years of experience working in a physician's office, pharmacy, or healthcare facility</li><li>
2 years of experience processing medication prior authorizations (Commercial, Medicare, Medicaid, and marketplace plans)<ul><li>
5 years of experience processing medication prior authorizations preferred</li></ul></li><li>
Strong computer literacy, including Microsoft Office Suite and EMR/EHR systems</li><li>
Ability to read, interpret, and apply medical terminology and clinical documentation</li><li>
Ability to multitask and work effectively in a high-volume, fast-paced, and deadline-driven environment</li><li>
Strong communication skills with the ability to interact with insurance companies via phone, fax, and electronic portals</li><li>
Strong organizational skills and attention to detail</li><li>
Ability to maintain confidentiality and follow HIPAA regulations</li><li>
Problem-solving ability to investigate denials and determine next steps</li><li>
Comfort navigating payer websites and electronic authorization systems</li><li>
Experience with Cerner preferred</li><li>
Medical Assistant or Pharmacy Technician preferred</li></ul><br>
<b>
Company Benefits and Perks:</b><br>
Joining Infinx comes with an array of benefits, flexible work hours when possible, and a genuine sense of belonging to a dynamic and growing organization.<ul><li>
Access to a 401(k) Retirement Savings Plan.</li><li>
Comprehensive Medical, Dental, and Vision Coverage.</li><li>
Paid Time Off.</li><li>
Paid Holidays.</li><li>
Additional benefits, including Pet Care Coverage, Employee Assistance Program (EAP), and discounted services.</li></ul>
If you are a dedicated and experienced Prior Authorization Specialist ready to contribute to our mission and be part of our diverse and inclusive community, we invite you to apply and join our team at Infinx.<br>
<p>
</p><p>bACcnwFK0M</p></div>

Prior Authorization Specialist

Sreenethra Eye Care

<p><b>Insurance Verification &amp; Pre-Authorization</b></p><ul><li>Verify patient insurance eligibility and coverage details.</li><li>Obtain pre-authorization approvals before surgery or procedures.</li><li>Coordinate with doctors and counselors for required documentation.</li><li>Ensure approval letters are received and properly filed.</li></ul><p>2. <b>Patient Counseling</b></p><ul><li>Explain insurance coverage, exclusions, and patient liability.</li><li>Inform patients about co-payment, deductibles, and non-covered items.</li><li>Guide patients in completing insurance forms accurately.</li></ul><p>3. <b>Claim Processing</b></p><ul><li>Prepare and submit insurance claims accurately and on time.</li><li>Ensure all required documents (ID proof, investigation reports, discharge summary, bills, operative notes, etc.) are attached.</li><li>Maintain proper documentation and records of submitted claims.</li></ul><p>4. <b>Follow-Up &amp; Reimbursement</b></p><ul><li>Follow up with insurance companies/TPAs for claim status.</li><li>Respond to queries or deficiencies raised by insurers.</li><li>Track pending claims and ensure timely settlement.</li><li>Coordinate with accounts department for payment reconciliation.</li></ul><p>5. <b>Coordination &amp; Communication</b></p><ul><li>Act as liaison between hospital, patient, insurance company, and TPA.</li><li>Communicate approval or rejection status to concerned departments.</li><li>Coordinate with front office, billing, and medical records departments.</li></ul><p>6. <b>Compliance &amp; Documentation</b></p><ul><li>Ensure all processes comply with insurance and hospital policies.</li><li>Maintain updated knowledge of various insurance schemes (e.g., private insurance, corporate, government schemes).</li><li>Maintain confidentiality of patient information.</li></ul><p>Job Type: Full-time</p><p>Pay: ₹18,000.00 - ₹22,000.00 per month</p><p>Experience:</p><ul><li>Insurance verification: 2 years (Required)</li></ul><p>Work Location: In person</p>

Insurance Coordinator

Southwestern Colorado Ear, Nose & Throat Associates

<p><b>Company Overview</b><br/>Southwestern Colorado Ear, Nose &amp; Throat Associates is dedicated to providing comprehensive and compassionate care to patients with ear, nose, and throat conditions. Our team of experienced healthcare professionals strives to deliver the highest standard of medical treatment in a welcoming and supportive environment.</p><p><b>Job Summary</b><br/>We are seeking a detail-oriented and proactive Scheduling &amp; Eligibility Coordinator to join our healthcare team. The ideal candidate will possess strong administrative skills, extensive experience with electronic health record (EHR) systems, and a thorough understanding of medical billing and insurance verification processes. As a key member of our clinic, you will coordinate patient appointments, verify insurance eligibility, and ensure accurate documentation to facilitate smooth clinic operations and optimal patient care.</p><p><b>Responsibilities</b></p><ul><li>Schedule patient appointments efficiently using eClinical EHR systems while maintaining accuracy and timeliness.</li><li>Verify patient insurance coverage and eligibility, including Medicare and Medicaid, ensuring all necessary authorizations are obtained prior to appointments.</li><li>Review medical documentation for completeness and accuracy, supporting proper coding practices including CPT, ICD-9, ICD-10, and ICD coding standards.</li><li>Collaborate with clinical staff to coordinate care plans and ensure proper documentation review for billing purposes.</li><li>Maintain detailed records of patient interactions, appointment changes, and insurance information in compliance with HIPAA regulations.</li><li>Assist patients with inquiries related to scheduling, insurance verification, and billing processes via phone or in person with professional phone etiquette.</li><li>Utilize multiple computer systems such as Meditech, Epic, eClinicalWorks, PACS or Labcorp to manage patient information efficiently.</li><li>Support office management by handling clerical tasks including filing, data entry, and managing multi-line phone systems in a fast-paced clinic environment.</li></ul><p><b>Requirements</b></p><ul><li>Proven experience in medical scheduling, eligibility verification, or medical administrative support within a healthcare setting.</li><li>Familiarity with EMR (Electronic Medical Records) systems such as eClinical Works is a plus.</li><li>Knowledge of medical billing procedures including insurance verification and CPT coding standards.</li><li>Strong understanding of medical terminology, ICD coding (ICD-9/ICD-10), and documentation review processes.</li><li>Excellent computer skills with proficiency in Microsoft Office Suite; typing speed of at least 10 keys per second preferred.</li><li>Ability to communicate effectively with patients and staff while demonstrating professionalism and empathy.</li><li>Bilingual abilities are desirable to serve diverse patient populations effectively.</li><li>Previous clinic or dental office experience is advantageous; familiarity with health information management systems is preferred.</li><li>Strong organizational skills combined with attention to detail in managing multiple priorities simultaneously. Join our dedicated team as a Scheduling &amp; Eligibility Coordinator to help streamline operations while providing exceptional service that enhances patient experiences at every visit!</li></ul><p>Pay: $19.00 - $21.50 per hour</p><p>Work Location: In person</p>

Scheduling & Eligibility Coordinator

Northern Arizona Healthcare

<div>Overview:
<div>
The Patient Access Representative is responsible for the verification and collection of patient demographic and insurance information by direct data entry to the electronic medical record during the scheduling/pre-admit or admission process prior to discharge. S/he conducts an interview with the patient or authorized representative to secure information specific to requested services; accurately documenting the discussion and other registration/scheduling activities in the encounter.</div>
Responsibilities:
<div><div><div><div><div><div><b>Patient Registration and Scheduling</b></div><div><ul><li>Demonstrates ability to navigate web-based products or system applications required for registration or scheduling.</li></ul><br>
<ul><li>Accurate identification of patient for direct data entry of required clinical, demographic, and insurance information to the electronic medical record during registration or for appointment booking of assigned diagnostic procedures.</li></ul><br>
<ul><li>Provides general explanation of scheduled procedures and patient instructions that are necessary for conducting diagnostic medical services.</li></ul><br>
<ul><li>Ensures system documentation specific to the patient visit is entered and accurately reflects activities related to patient or provider contact, order documentation, insurance verification, financial education, and payment.</li></ul><br>
<ul><li>Provides explanation of legal forms and secures signature of patient/authorized party as required for services.</li></ul><br>
<ul><li>Demonstrates basic understanding of compliance standards required within a healthcare environment including EMTALA and HIPAA-Privacy Patient Confidentiality regulations.</li></ul></div></div></div><br>
</div></div></div><div><div>
</div><div><div><div><div><div><b>
Insurance Verification</b></div><div><ul><li>Accurate identification and selection of insurance carrier in the patient medical record for specified dates of medical services.</li></ul><br>
<ul><li>Navigation of web-based products or system applications to initiate and document insurance eligibility, benefit details, and authorization requirements.</li></ul><br>
<ul><li>Performs required notifications to ensure insurance authorization for identified medical services, surgical procedures, and inpatient/observation stays are secured and documented.</li></ul><br>
<ul><li>Demonstrates basic knowledge of CPT and ICD10 diagnosis coding documentation as required for medical services.</li></ul></div></div></div><br>
</div></div></div><div><div>
</div><div><div><div><div><div><b>
Financial Counseling</b></div><div><ul><li>Demonstrates basic knowledge of regulatory or Third Party Payer insurance requirements including Medicare, AHCCCS/Medicaid, Workers Comp and other commercial payers.</li></ul><br>
<ul><li>Educates the patient on insurance eligibility, coverage, and availability of medical financial assistance program(s).</li></ul><br>
<ul><li>Collects identified patient financial liabilities; performs secured payment entry and deposit/cash reconciliation steps.</li></ul></div></div></div><br>
</div></div></div><div><div>
</div><div><div><div><div><div><b>
Revenue Cycle Support</b></div><div><ul><li>Performs PBX Switchboard functions as required for answering and routing of internal/external calls; paging codes and fire alarms; handles department call volumes as assigned to appropriately respond to requests from patients, providers, or other hospital departments.</li></ul><br>
<ul><li>Acts as a resource for clinical departments for registration/scheduled services related to data entry of patient account fields, provider order requirements, and questions regarding insurance coverage or financial assistance.</li></ul></div></div></div><br>
</div></div></div><div><div>
</div><div><div><div><div><div><b>
Compliance/Safety</b></div><div><ul><li>Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.</li></ul><br>
<ul><li>Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.</li></ul><br>
<ul><li>If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.</li></ul><br>
<ul><li>Completes all company mandatory modules and required job-specific training in the specified time frame.</li></ul></div></div></div><br>
</div></div></div>
Qualifications:
<div><div><div><div><div><div><div><b>Education</b></div></div><br>
</div></div></div></div><div><div><ul><li>
High School Diploma or GED- Required<br>
</li><li>
Medical Terminology Coursework- Preferred</li></ul></div></div></div><div><div><div><div>
</div></div></div></div><div><div><div><div><div><div><div><b>
Experience</b></div></div><br>
</div></div></div></div><div><div><ul><li>
1 year in a customer service role- Required<br>
</li><li>
Proficiency in Microsoft Applications (Excel, Word, PowerPoint)- Preferred<br>
</li><li>
2 years experience in a medical facility, health insurance, or related medical field- Preferred</li></ul><div><br>
Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.</div></div></div></div></div>

Patient Access Representative, Nights - Sedona/Cottonwood, AZ

Tech Pinacle Innovation Pvt Ltd

<p><b>Job Title:</b> Insurance &amp; Authorization Analyst (Revenue Cycle / Patient Access)</p><p><b>Role Overview</b></p><p>The Insurance &amp; Authorization Analyst is responsible for supporting and optimizing insurance coverage verification and prior authorization workflows within healthcare systems. This role ensures accurate benefit validation, rule configuration, and timely prior authorization approvals to reduce denials and improve revenue cycle performance.</p><p>The ideal candidate has strong experience in coverage workflows, authorization management, rule configuration, and payer coordination across hospital and ambulatory environments.</p><p><b>Key Responsibilities</b></p><p><b>Coverage &amp; Authorization Workflows</b></p><ul><li>Support end-to-end insurance workflows including:</li><li>Eligibility verification</li><li>Benefits validation</li><li>Referral tracking</li><li>Prior authorization submission and follow-up</li><li>Configure and maintain insurance plans, payers, and benefit structures.</li><li>Ensure accurate capture of coverage information during scheduling and registration.</li><li>Monitor authorization status to prevent delays in patient care.</li></ul><p><b>Rule Configuration &amp; System Build</b></p><ul><li>Configure and maintain:</li><li>Coverage validation rules</li><li>Authorization triggers based on CPT/HCPCS codes</li><li>Medical necessity checks</li><li>Payer-specific documentation requirements</li><li>Build edits and alerts to prevent scheduling without required authorization.</li><li>Support testing and validation of build changes during system upgrades.</li><li>Collaborate with IT teams to implement workflow enhancements.</li></ul><p><b>Prior Authorization Optimization</b></p><ul><li>Analyze denial trends related to authorization issues.</li><li>Identify bottlenecks in the prior authorization process.</li><li>Develop standardized workflows for high-volume procedures.</li><li>Optimize automation for authorization tracking and reminders.</li><li>Implement best practices to improve approval turnaround time (TAT).</li></ul><p><b>Payer &amp; Stakeholder Collaboration</b></p><ul><li>Coordinate with insurance companies and third-party administrators.</li><li>Partner with clinical departments to gather medical necessity documentation.</li><li>Work closely with revenue cycle and billing teams to reduce claim denials.</li><li>Train front-desk and scheduling teams on authorization requirements.</li></ul><p><b>Reporting &amp; Analytics</b></p><ul><li>Develop and maintain reports on:</li><li>Authorization turnaround time</li><li>Denial rates related to coverage issues</li><li>Missing or incomplete authorizations</li><li>Monitor KPIs to improve first-pass claim success rates.</li><li>Provide insights to leadership on revenue impact and process improvements.</li></ul><p><b>Compliance &amp; Risk Management</b></p><ul><li>Ensure compliance with payer policies and regulatory requirements.</li><li>Maintain documentation for audit readiness.</li><li>Protect patient financial and coverage data integrity.</li></ul><p><b>Required Qualifications</b></p><ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Health Informatics, Finance, or related field (or equivalent experience).</li><li>4+ years of experience in insurance verification and prior authorization workflows.</li><li>Strong understanding of revenue cycle and patient access processes.</li><li>Experience configuring insurance and authorization rules in healthcare systems.</li><li>Knowledge of CPT/HCPCS coding and medical necessity requirements.</li><li>Strong analytical and problem-solving skills.</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Experience with enterprise EHR systems (e.g., Epic, Cerner, Meditech).</li><li>Experience working with clearinghouses and payer portals.</li><li>Knowledge of denial management processes.</li><li>Experience in multi-specialty or hospital-based environments.</li></ul><p><b>Key Competencies</b></p><ul><li>Insurance Verification &amp; Coverage Management</li><li>Prior Authorization Workflows</li><li>Rule Configuration &amp; Validation</li><li>Revenue Cycle Optimization</li><li>Denial Reduction Strategies</li><li>Payer Coordination</li><li>Data Analysis &amp; Reporting</li><li>Cross-Functional Collaboration</li></ul><p>Job Types: Full-time, Permanent</p><p>Pay: ₹239,281.03 - ₹982,224.09 per year</p><p>Work Location: Hybrid remote in Noida</p>

Insurance & Authorization Analyst

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