Insurance Authorization Specialist II

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

• Secure authorizations for elective procedures, services, and tests to ensure financial clearance for patients before services are provided.

• Utilize payor resources, medical policies, and reference materials to confirm prior authorization requirements.

• Code cases and assess clinical documentation for thoroughness.

• Report financial clearance risks in accordance with the Financial Clearance Program.

• Identify patients who need pre-certification or pre-authorization.

• Communicate with insurance companies or employers to verify eligibility and benefits.

• Utilize EPIC work queues to secure authorizations for referrals, tests, and surgeries within designated timeframes.

• Follow up on authorization requests, peer-to-peer reviews, denials, and prior authorization appeals.

• Ensure that diagnosis, procedure, and facility coding correspond with the acquired authorization.

• Confirm services promptly to prevent treatment delays and minimize administrative time.

• Support Patient Financial Services with denial management and obtain retro-authorizations as necessary.

• Inform scheduling staff and physicians about cases that are not authorized in accordance with department policy.

• Adhere to compliance with quality standards and productivity metrics.

• Collaborate with physicians, financial clearance counselors, schedulers, nurses, patients, families, and other stakeholders.

• Manage EPIC in-baskets and Outlook emails effectively.

• Engage in monthly team meetings and one-on-one sessions.

• Follow established workflows and communicate any process or system shortcomings to supervisors or managers.

• Uphold the confidentiality of demographic, clinical, and financial information.

⛳️ Requirements

• High school diploma or equivalent with 2 years of experience in a medical setting, or an Associate’s degree with 1 year of experience in a medical environment is required.

• Minimum of 3 years’ experience with medical terminology, ICD-10, and CPT coding.

• Familiarity with authorization processes, insurance regulations, and third-party payors.

• Proficient in Microsoft Office applications.

• Strong communication and interpersonal capabilities.

• Ability to prioritize tasks, meet deadlines, and efficiently manage a large workload with attention to detail.

• Basic computer proficiency.

• Practical understanding of medical terminology, ICD-10 and CPT coding, third-party payors, time-of-service collection procedures, and business mathematics.

• Minimum typing speed of 25 words per minute.

• Exceptional reading comprehension and analytical skills.

• Capacity to work for extended periods while sitting and on the phone.

• Manual dexterity required to operate keyboards, fax machines, telephones, and other office equipment.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment focused on teamwork and collaboration.