Benefits and Authorization Specialist

The Authorization and Benefits Specialist is responsible for the full lifecycle of insurance verification and authorization. This role ensures financial reimbursement by securing pre-authorizations obtaining retroactive approvals and maintaining active authorizations for ongoing care. The Specialist serves as a liaison between the organization third-party payors and clinical staff to prioritize efficiency.

JOB-SPECIFIC FUNCTIONS :

Authorization Management : Initiate and secure initial benefits pre-authorizations and re-authorizations via payor portals fax or telephone.

Follow-Up & Tracking : Strictly adhere to follow-up schedules (e.g. 3 7 14 30 days) based on payor guidelines to expedite claims and prevent revenue loss.

Complex Case Resolution : Manage high-complexity requests including retroactive authorizations and Single Case Agreements (SCAs) for out-of-network patients.

Data Integrity : Verify that authorization quantities CPT codes and effective dates are accurately entered into the practice management system.

Clinical Collaboration : Coordinate directly with healthcare providers to secure necessary clinical notes letters of medical necessity and supporting documentation in a timely manner.

Process Improvement : Develop and maintain a centralized Payor Master List and internal authorization manuals to standardize workflows and improve efficiency.

• Compliance : Review and interpret insurance group pre-certification requirements to ensure full compliance before services are rendered.

Qualifications :

Education : Associates of Bachelors degree preferred in Healthcare Administration or related field preferred.

Experience : Minimum of 2 years of experience in insurance verification medical billing or authorization management.

Technical Skills : Proficiency with electronic medical records (EMR) systems and payor portals.

Additional Information :

Remote Work : No

Employment Type : Full-time

Key Skills

Customer Service,Fmla,HIPAA,Microsoft Outlook,Benefits Administration,HRIS,Payroll,Employment & Labor Law,ADP,Human Resources,Phone Etiquette,Workday

Department / Functional Area : Operations

Experience : years

Vacancy : 1