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We are seeking a detail-oriented Insurance Authorization Specialist to support timely and accurate insurance verification and prior authorization processes. This role is responsible for reviewing patient and provider information, obtaining required authorizations, confirming coverage, and helping ensure claims are processed efficiently. The ideal candidate has strong knowledge of insurance guidelines, excellent communication skills, and the ability to manage multiple cases in a fast-paced environment.
Job Responsibility:
Verify insurance eligibility, benefits, and coverage details
Obtain prior authorizations and pre-certifications for services, procedures, and medications
Communicate with insurance carriers, providers, patients, and internal teams regarding authorization requirements and status updates
Review documentation for completeness and accuracy before submission
Track authorization requests, approvals, denials, and expirations
Follow up on pending and denied authorizations and escalate issues as needed
Maintain accurate records in billing, practice management, or electronic health record systems
Ensure compliance with payer guidelines, healthcare regulations, and company policies
Assist with appeals and supporting documentation for denied requests
Collaborate with clinical, billing, and administrative teams to reduce delays in service and reimbursement
Requirements:
High school diploma or equivalent required
associate degree preferred
1+ years of experience in insurance authorization, medical billing, healthcare administration, or a related role preferred
Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans
Familiarity with prior authorization and eligibility verification processes
Experience with electronic health records and insurance portals
Strong attention to detail and organizational skills
Excellent verbal and written communication skills
Ability to manage deadlines and work independently in a high-volume environment