Job Summary:

The Insurance Authorization Specialist secures approval from insurance carriers for medical services, procedures, or medications before they are rendered. Verify patient eligibility, submit clinical documentation, track authorization status, and manage denials to ensure reimbursement and facilitate timely patient care. Key skills include medical terminology, EHR proficiency, and strong communication.

Core Responsibilities:

• Authorization Submission: Initiate, review, and track prior authorization requests for medical procedures, medications, or referrals with insurance companies.
• Verification: Confirm patient insurance eligibility and benefits, ensuring compliance with payer requirements.
• Documentation: Review clinical records for accuracy to support medical necessity for treatment.
• Communication: Act as a liaison between providers, patients, and insurance carriers to resolve questions or denials.
• Records Management: Maintain detailed logs of all communication and approval statuses in electronic medical records (EMR).

Required Skills and Qualifications:

• Education: High school diploma or GED required; associate degree or medical billing/coding certification is preferred.
• Experience: Previous experience in healthcare, specifically in insurance verification, or prior authorization.
• Physical Therapy focus is beneficial, but not required
• Knowledge: Proficiency in medical terminology and insurance coding (ICD-10, CPT).
• Skills: Strong communication (verbal/written), attention to detail, multitasking, and computer proficiency (MS Office, EHR systems).

Key Competencies

• Problem-Solving: Ability to resolve denied or pending claims.
• Organization: Managing high-volume, time-sensitive tasks.
• Customer Service: Professional interaction with patients regarding coverage issues.