Insurance Authorization Specialist
New
USFull-TimeMiddle
Salary17 - 18.65 USD per hour
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Job Details
- Experience
- Minimum of 2 years of experience in insurance authorization or a related healthcare administrative role.
- Required Skills
- Data entry
Requirements
- High school diploma or GED required.
- Minimum of 2 years of experience in insurance authorization or a related healthcare administrative role.
- Knowledge of medical coding, billing systems, clinical documentation, and healthcare regulatory requirements.
- Understanding of insurance authorization processes, appeals concepts, and payer requirements.
- Strong analytical skills with the ability to review information, identify issues, and determine appropriate solutions.
- Excellent written and verbal communication skills with the ability to explain medical information clearly.
- Ability to manage confidential information with professionalism and sound judgment.
- Strong attention to detail, organization, and ability to prioritize multiple tasks effectively.
- Openness to innovation, including the use of technology and AI solutions to improve healthcare processes.
- Revenue cycle certification is required within 9 months of hire, with certification support provided.
Responsibilities
- Review scheduled patient services and identify insurance authorization requirements based on payer guidelines and plan-specific criteria.
- Select and evaluate appropriate clinical documentation to support authorization requests and ensure patient safety.
- Submit authorization requests to insurance companies and follow up to obtain approvals within required timelines.
- Serve as a liaison between healthcare providers, physician offices, and insurance companies to communicate requirements and resolve authorization issues.
- Analyze authorization challenges, identify process improvement opportunities, and support efficient workflows.
- Maintain accurate records while handling confidential patient and insurance information in accordance with regulatory standards.
- Apply knowledge of medical coding, billing practices, documentation requirements, and healthcare compliance guidelines.
- Communicate medical information clearly and professionally with internal teams, providers, payers, and other stakeholders.
- Adapt to evolving processes, technology solutions, and innovative approaches to improve patient and client experiences.
- Support business needs by maintaining flexibility with schedules and assisting with operational priorities when required.
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