Benefits and Authorization Specialist

Benefits and Authorization Specialist

The Benefits and Authorization Specialist is responsible for verifying patient insurance coverage, obtaining pre-authorizations, and providing financial assistance support to ensure patients receive necessary medical services. This role involves coordinating with insurance companies, healthcare providers, and patients to manage benefits and authorizations efficiently.

• Verify patient insurance coverage and benefits for medical services.
• Communicate with insurance companies to confirm patient eligibility and coverage details.
• Provide patients with clear and accurate information regarding their benefits and financial responsibilities.
• Obtain prior authorizations for medical procedures and services as required by insurance providers.
• Track and follow up on pending authorizations to ensure timely approval.
• Maintain accurate records of authorization requests and approvals.
• Serve as a point of contact for patients regarding their insurance benefits and authorization status.
• Address patient inquiries and concerns with empathy and professionalism.
• Educate patients on their insurance plans and assist them in understanding their coverage.
• Work closely with healthcare providers to gather necessary documentation for authorization requests.
• Coordinate with medical staff to ensure all required information is submitted to insurance companies.
• Facilitate communication between providers and insurance companies to resolve any issues.
• Maintain detailed and accurate records of all patient interactions, benefits verifications, and authorization requests.
• Ensure compliance with all regulatory and organizational policies regarding patient information and documentation.
• Regularly update patient records in the electronic health record (EHR) system.

• High School Diploma/GED
• At least 2 year(s) of experience in healthcare setting, preferably in patient benefits, insurance verification, or authorization roles.

• Associate's Degree in healthcare administration, business, or a related field
• At least 3 year(s) of experience in medical billing or insurance authorization.
• Certification in medical billing and coding (e.g., CPC, CPB)
• Prior Authorization Certified Specialist (PACS) certification.

$45,000 + depending on qualifications

• Standard office environment

• Repetitive use of a keyboard

• Resume/CV
• 3 work references with their contact information; at least one reference should be from a supervisor
• Letter of interest