Authorization Specialist

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Secure authorizations and benefits for surgical procedures, diagnostic tests, medications, outgoing referrals, and various other services.

• Identify authorization guidelines for each health plan.

• Carry out billing responsibilities to ensure accurate and timely payments from insurance providers and patients.

• Work in conjunction with physicians and provider office personnel to determine the appropriate authorization based on medical necessity and treatment strategies.

• Conduct medical necessity assessments to verify that the procedure and diagnosis align with medical necessity criteria.

• Ensure that authorizations adhere to network policies and relay any exceptions to the ordering office, patient, and manager.

• Interact with insurance companies to secure insurance verification, benefits information, and precertification approvals.

• Confirm additional clinical details and insurance authorizations/referrals.

• Review and oversee WQs/schedules to guarantee proper and accurate authorization prior to patient visits.

• Maintain compliance with benchmark data regarding accounts registered compared to scheduled procedures.

• Calculate estimated patient financial responsibility using information from insurance verification, payer contracts, and/or self-pay guidelines.

⛳️ Requirements

• High School Diploma/GED with specialized training in insurance, coding, billing, or equivalent healthcare certification programs.

• At least 1 year of experience in a healthcare environment focusing on insurance verification/authorizations.

• Knowledge of billing processes and payer reimbursement practices.

• Understanding of patient rights and related laws, including HIPAA regulations.

• Skilled in utilization management processes, standards, and managed care principles.

• Familiarity with standard medical practices and insurance benefit frameworks.

• Capability to lift and carry weights of up to 25 lbs.

• Frequent sitting/standing and keyboard usage required.

🏝️ Benefits

• Full-time employment opportunity.

• Day shift hours.

• Work schedule from Monday to Friday, 8:00 AM to 4:30 PM.