Authorization Specialist

• Support prior authorization requests and ensure they are addressed properly within contractual timelines
• Aid the utilization management team in documenting authorization requests
• Obtain accurate and timely documentation for member healthcare eligibility and access
• Support authorization requests according to the insurance prior authorization list
• Perform data entry to maintain and update authorization requests in the utilization management system
• Assist with tracking and documenting authorizations and referrals according to policies and guidelines
• Document medical information including history, diagnosis, and prognosis for clinical reviewer determination
• Stay up-to-date on healthcare, authorization processes, policies, and procedures
• Perform other assigned duties
• Comply with all policies and standards

Authorization Specialist supporting prior authorizations for Centene’s healthcare members

Authorization Specialist I

Authorization Specialist supporting prior authorization workflows for Centene, a national healthcare organization serving 28 million members. Documenting medical information, referrals, and utilization management records.

• Monitor authorizations of upcoming surgical cases on physician calendars, ensuring surgeries are authorized in a timely and accurate manner
• Verify patient demographic information and insurance eligibility, including coordination of benefits
• Update and confirm information needed to process claims with insurance plans
• Complete surgical cost analysis forms and document required surgical cost estimates for collection before services
• Verify benefits on all surgical procedures
• Document authorizations and authorization progress in patient charts
• Enter authorization information within case management
• Communicate effectively with physicians, patients, and co-workers and establish good working relationships with internal and external customers
• Participate in ongoing staff training and education regarding new processes
• Work with the department manager to respond to and reduce complaints promptly and professionally
• Assist surgery schedulers with STAT authorizations
• Maintain strict confidentiality of health records and member information and comply with HIPAA guidelines
• Identify opportunities to improve daily workflow processes
• Attend department meetings as required

Post-surgical authorization specialist coordinating surgical approvals for HOPCo healthcare clinics

Surgical Authorization Specialist

Post-surgical authorization specialist coordinating surgical approvals and insurance verification for HOPCo healthcare clinics. Managing patient records, benefits, claims information, and STAT authorizations.

• Monitor authorizations for upcoming surgical cases on physicians’ calendars, ensuring surgery authorizations are obtained timely and accurately
• Verify patient demographic information and insurance eligibility, including coordination of benefits
• Update and confirm information needed to process claims to insurance plans
• Complete surgical cost analysis forms and document surgical cost estimates for collection before services
• Verify benefits on all surgical procedures
• Document authorizations and authorization progress in patient charts
• Enter authorization information in case management
• Communicate effectively with physicians, patients, and coworkers and establish good working relationships with internal and external customers
• Provide ongoing staff training and education on new processes to ensure timely confirmation of surgical cases
• Work with the department manager to respond to and reduce complaints in a timely and professional manner
• Assist surgery schedulers with STAT authorizations
• Maintain strict confidentiality of health records and member information and follow HIPAA guidelines
• Identify opportunities to improve daily workflow processes
• Attend department meetings as required

Surgical authorization specialist coordinating surgery approvals for Outcomes by HOPCo’s healthcare clinics

Surgical authorization specialist coordinating surgery approvals, insurance verification, and cost estimates for Outcomes by HOPCo’s healthcare clinics.
Supporting surgical schedulers, staff training, claims processing, and HIPAA-compliant patient record management.

• Checking eligibility/benefits on patients as needed
• Communicating any patients that will have a patient responsibility
• Tracking and obtaining all authorizations for all locations
• Data entering all authorization information into the system
• Verifying accuracy in payor setup in EMR for all active policies
• Maintain electronic record of all authorizations
• Run reports daily, weekly, and monthly for department
• Communicate with both internal and external customers to ensure authorizations are utilized accurately

Authorization Specialist handling insurance authorization requests

Authorization Specialist I, RCM

Authorization Specialist handling insurance authorization requests for all patients. Collaborating with field-based leadership to track eligibility and maintain authorization records.

• Work closely with ABA / behavioral health providers and their billing teams to collect accurate patient information and communicate authorization decisions
• Work with insurers to verify patient eligibility and benefits, and expediently complete prior authorizations using insurance portals or calling insurers directly. Ensure authorization is approved in a timeline manner by following up with insurers and providing additional information
• Be responsible for handling multiple prior authorizations simultaneously and create process to ensure top of the line performance
• Understand ABA- and other behavioral health-specific workflows, including creating treatment plans, re-authorization
• Become a subject matter expert in behavioral health prior authorization workflows for large insurers
• Work closely with Silna Product/Engineering teams to share learnings about the prior authorization process to help automate parts of it
• Communicate effectively across multiple stakeholders
• Be willing to work 40 hours per week

ABA Authorization Specialist supporting providers in prior authorizations and benefit verifications

ABA Authorization Specialist

ABA Authorization Specialist working remotely to assist providers with prior authorizations and benefits verifications. Collaborating with various stakeholders to improve workflow efficiency and patient care access.

• Responsible for performing a variety of patient registration, scheduling, and insurance verification duties
• Answers phone calls from patients with professionalism and efficiency
• Responds to routine inquiries regarding online and in office scheduling
• Drives requests, tracking, and obtaining of pre-authorization from insurers within time allotted
• Strong customer service skills in daily interaction with the public, patients, staff, and physicians
• Scheduling, changing, and updating patient appointments
• Interview patients for demographic information and evaluate eligibility
• Contact insurance carriers to verify eligibility, benefits, and requirements
• Process insurance authorizations and update patient records
• Research referrals to deny or approve based on information obtained
• Communicate any insurance changes or trends among team

Scheduler and Authorization Specialist at Centers for Advanced Orthopaedics

Scheduler – Authorization Specialist

Scheduler and Authorization Specialist performing patient registration and scheduling tasks. Ensuring compliance and providing excellent customer service at Centers for Advanced Orthopaedics.

• Perform a variety of patient registration, scheduling, and insurance verification duties
• Answer phone calls from patients with professionalism and efficiency
• Respond to routine inquiries regarding online and in office scheduling
• Drive requests, tracking, and obtaining of pre-authorization from insurers
• Exhibit strong and care-focused customer service skills in daily interaction with the public, patients, staff, and physicians
• Schedule, change, and update patient appointments
• Interview patients for demographic information, evaluate eligibility, and collect co-pays
• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements
• Process insurance authorizations and update patient records
• Respond to patient inquiries, questions, and scheduling requests

Scheduler and Authorization Specialist at Centers for Advanced Orthopaedics performing patient registration and scheduling

Scheduler and Authorization Specialist at CAO managing patient registrations and insurance verifications. Conducting scheduling and client communications within a large medical practice network.

• Verify benefits and eligibility prior to admission and throughout treatment
• Complete pre-certifications, concurrent reviews, and re-certifications for PHP/IOP levels of care
• Obtain Single Case Agreements with out-of-network payers
• Build the medical necessity case using ASAM, LOCUS, and CALOCUS criteria
• Prepare and submit appeals on denied authorizations
• Maintain accurate, audit-ready authorization, denial, and SCA records

Behavioral Health UR/Authorization Specialist managing insurance authorization for mental health programs

Behavioral Health UR/Authorization Specialist

Behavioral Health UR/Authorization Specialist managing insurance authorizations for PHP and IOP programs. Ensuring client access to treatment by handling pre-certifications and appeals.

• Monitors the authorizations of upcoming surgical cases on the physician’s calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
• Completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
• Verifies benefits on all surgical procedures.
• Document authorizations and progress of authorizations in the patient’s chart.
• Enters the authorization information within case management.
• Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
• Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
• Work with the department manager to respond to and reduce complaints timely and professionally.
• Assist surgery schedulers with STAT authorizations.
• Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
• Assists in identifying opportunities for improvement within the daily workflow process.
• Attends department meetings as required.

Surgical Authorization Specialist monitoring and processing surgical case authorizations

Surgical Authorization Specialist in healthcare field ensuring authorizations for surgeries are timely and accurate. Verifying patient insurance eligibility and managing documentation for surgical cases.

• Works with payers and SEARHC clinical staff to obtain initial and ongoing authorizations for patient services
• Verifies insurance benefits for each patient
• Obtain authorizations for patients in accordance with the payer-provider contracts
• Responsible for tracking and correcting all pertinent insurance information in the electronic medical record
• Maintain strong working relationships with payers, SEARHC billing staff, and all other interdepartmental staff
• Provide excellent customer service
• Critical for reimbursement of costs relating to high dollar procedures and services provided to our patients
• Accurately captures and records inbound and outbound authorizations for patients and/or referring physician’s offices
• Carries out due diligence to obtain authorizations from various insurance carriers via phone, in writing or email
• Processes authorization-related denials and coordinates the appeal process with the appropriate Revenue Cycle staff members and clinical team
• Work closely with the Financial Counselors and Patient Access team to ensure coverage is current and documented appropriately in the record
• Ensure efficient documentation of information for insurance verification, registration and billing requirements and follows-up as needed
• Responds to inquiries regarding status of authorization(s) by assessing the request and evaluating the circumstances to provide the needed information
• Communicates effectively with patients, physicians, and/or other departments regarding delays or issues relating to authorizations and patient appointments
• Meets team metric standards and expectations consistently
• Maintains strict confidentiality at all times
• Identifies compliance/ethics issues and brings forth recommendations for operational improvement
• Ensures successful adherence to policies, procedures and changes to the organization
• Complete and support additional patient access related activities as assigned

Authorization Specialist managing patient service authorizations for SEARHC

Authorization Specialist II

Authorization Specialist managing authorizations for patient services in a non-profit health consortium. Collaborating with payers and clinical staff to ensure effective service delivery.

• Works with payers and SEARHC clinical staff to obtain initial and ongoing authorizations for patient services
• Verifies insurance benefits for each patient
• Tracks and corrects all pertinent insurance information in the electronic medical record
• Maintains strong working relationships with payers, SEARHC billing staff, and all other interdepartmental staff
• Provides excellent customer service at all times
• Captures and records inbound and outbound authorizations for patients and/or referring physician’s offices
• Carries out due diligence to obtains authorizations from various insurance carriers via phone, in writing or email
• Processes authorization-related denials and coordinates the appeal process with the appropriate Revenue Cycle staff members
• Ensures efficient documentation of information for insurance verification, registration and billing requirements and follows-up as needed
• Responds to inquiries regarding status of authorization(s) by assessing the request and evaluating the circumstances to provide the needed information
• Demonstrates superior customer service to all external and internal customers
• Communicates effectively with patients, physicians, and/or other departments regarding delay or issues relating to authorizations and patient appointments
• Meets team metric standards and expectations consistently
• Maintains strict confidentiality at all times
• Identifies compliance/ethics issues and brings forth recommendations for operational improvement

Authorization Specialist obtaining authorizations for patient services in Southeast Alaska.

Authorization Specialist securing authorizations for patient services and verifying insurance benefits in a healthcare setting. Collaborative role with payers and clinical staff across Southeast Alaska.

• Responsible for verifying insurance policy benefit information, and securing payer required authorizations.
• Obtains accurate and timely pre-authorizations for professional services prior to the patient's visit.
• Verifies insurance coverage via system tools, payer portals, etc. and updates changes in billing system.
• Confirms providers participation status with patients insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Researches system notes to obtain missing or corrected insurance or demographic information.
• Reviews clinical documentation to ensure criteria for procedure meets insurance requirements.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Follows through on pre-certifications until final approval is obtained.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Serves as back-up to Authorization-Referrals Specialist III.

Authorization Specialist II verifying insurance information for ColumbiaDoctors

Authorization Specialist II responsible for verifying insurance benefit information and securing authorizations for ColumbiaDoctors, a major healthcare provider.

• Perform insurance pre-certification duties for surgical procedures, MRI scans, and injections
• Make payment arrangements for estimated patient responsibility for surgical procedures and MRI scans
• Contact insurance companies for pre-certification and obtain insurance benefit information
• Contact patients regarding estimated responsibility amounts and review outstanding balances

Pre-Authorization specialist handling insurance pre-certifications and patient communications

Pre-Authorization Specialist

Pre-Authorization specialist handling insurance pre-certifications for surgical procedures in Laramie, WY. Contacting patients for payment arrangements and working with insurance companies.

• Review and process authorization requests accurately and efficiently
• Verify customer information and supporting documentation for completeness
• Communicate with clients, providers, vendors, and internal departments regarding authorization requirements
• Monitor pending authorizations and follow up to ensure timely resolution
• Maintain accurate records and update authorization status in company systems
• Respond to customer inquiries via phone, email, and online communication platforms
• Ensure all authorizations comply with company policies and regulatory requirements
• Escalate complex or urgent cases to the appropriate department when necessary
• Prepare reports and maintain confidential documentation
• Perform general administrative duties and other tasks assigned by management

Authorization Specialist reviewing and processing requests at Envita Medical Center

Authorization Specialist reviewing and processing authorization requests for Envita Medical Center. Working remotely to ensure compliance and exceptional customer service in a collaborative environment.

• Obtain and maintain prior authorization status for NELC patient medications/therapies
• Work closely with the clinical review department to obtain documentation needed to complete the authorization process
• Obtain needed documentation to support the billing department in meeting payer requirements for patient accounts

Authorization Specialist obtaining patient medication authorizations for home infusion provider

Remote Authorization Specialist for New England Life Care seeking to obtain patient medication authorizations and support billing processes. Requires 3 years authorization or billing experience in specified US states.

Authorization Specialist jobs in United States

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Authorization Specialist I

Surgical Authorization Specialist

Surgical Authorization Specialist

Authorization Specialist I, RCM

ABA Authorization Specialist

Scheduler – Authorization Specialist

Scheduler – Authorization Specialist

Behavioral Health UR/Authorization Specialist

Surgical Authorization Specialist

Authorization Specialist II

Authorization Specialist I

Authorization Specialist II

Pre-Authorization Specialist

Authorization Specialist

Authorization Specialist