Authorization Specialist ON-SITE

About the Role

The Authorization Specialist will obtain prior authorizations for surgeries and all modalities including diagnostic imaging, cardiac imaging, procedures, prescription medications, Veterans Administration authorizations, some durable medical equipment, and outside referral authorizations. This position ensures that prior authorizations are completed promptly and accurately. This position is responsible to properly document in the electronic health record per the Prior Authorization protocol.

• High school diploma or equivalent; associate degree or higher preferred.
• At least 1-2 years of experience in medical authorization, insurance verification, or a related administrative role.
• Strong knowledge of insurance plans, medical terminology, and healthcare authorization processes.
• Proficiency with electronic health records (EHR) systems and authorization management software.
• Excellent communication and organizational skills.
• Experience working with multiple insurance payers and familiarity with payer-specific authorization requirements.
• Certification in medical billing, coding, or healthcare administration (e.g., CPC, CPAM).
• Demonstrated ability to handle high-volume workloads while maintaining accuracy and attention to detail.
• Strong problem-solving skills and the ability to work independently and as part of a team.

• Review and process authorization requests for services or products in accordance with company policies and payer requirements.
• Communicate with healthcare providers, insurance companies, and internal departments to obtain necessary documentation and approvals.
• Verify patient insurance coverage and eligibility to determine authorization requirements.
• Maintain accurate records of all authorization activities and update relevant databases or systems.
• Resolve discrepancies or denials by investigating issues and coordinating with appropriate parties to secure approvals.
• Stay current with changes in insurance policies, regulations, and industry best practices to ensure compliance.
• Provide timely updates to patients, providers, and internal teams regarding the status of authorization requests.

A conditional job offer is contingent upon successfully passing a pre-employment drug test and background checks. A Physical Capacity Profile may be required for some positions.