Authorizations Specialist
We are seeking a detail-oriented and patient-focused Authorizations Specialist to join our hospital team. In this role, you will be responsible for obtaining and managing insurance authorizations for outpatient and inpatient services while ensuring compliance with payer requirements. The ideal candidate has strong knowledge of medical insurance, excellent communication skills, and the ability to thrive in a fast-paced healthcare environment.
Essential Responsibilities:
* Obtain prior authorizations and pre-certifications from commercial, Medicare, Medicaid, and managed care insurance plans.
* Verify patient insurance eligibility, benefits, and coverage requirements.
* Review physician orders and clinical documentation to ensure authorization requests meet payer guidelines.
* Submit authorization requests accurately and follow up to secure timely approvals.
* Communicate authorization status to physicians, clinical staff, scheduling teams, and patients.
* Monitor pending authorizations and resolve issues that may delay patient care.
* Document all authorization activity in the electronic medical record (EMR) and other applicable systems.
* Coordinate with insurance companies to appeal denied or delayed authorization requests when appropriate.
* Maintain current knowledge of payer policies, authorization requirements, and regulatory guidelines.
* Provide exceptional customer service while maintaining patient confidentiality in accordance with HIPAA regulations.
* Perform other duties as assigned.
Qualifications:
Qualifications
Required:
* High school diploma or equivalent.
* Minimum of 2 years of experience obtaining insurance authorizations in a hospital, medical group, specialty clinic, or healthcare setting.
* Knowledge of commercial insurance, Medicare, Medi-Cal, HMO, PPO, and managed care plans.
* Experience verifying insurance eligibility and benefits.
* Strong computer skills, including experience with EMR systems and Microsoft Office.
* Excellent organizational skills with the ability to manage multiple priorities.
* Strong verbal and written communication skills.
* Ability to work independently and collaboratively in a team environment.
Preferred:
* Associate's degree in Healthcare Administration or a related field.
* Experience with Epic or other hospital electronic medical record systems.
* Bilingual in English and Spanish.
Compensation
$25.00-$27.00 HourlyAbout Us
TalentMatch®
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