Authorizations
Responsibilities:
• Manage authorization and precertification requests for scheduled and unscheduled services across a range of government and commercial health plans.
• Confirm active coverage, benefit levels, and service-specific requirements before care is delivered to reduce claim and scheduling issues.
• Evaluate provider orders and supporting clinical records to prepare complete submissions that align with payer criteria.
• Track open requests, communicate with insurers, and take timely action to obtain determinations within required turnaround times.
• Share updates on approval, denial, or pending status with care teams, schedulers, physicians, and patients as needed.
• Investigate barriers that could interrupt treatment timelines and work with internal and external parties to resolve them quickly.
• Record authorization activity, follow-up efforts, and outcomes accurately within the electronic medical record and related billing systems.
• Assist with reconsiderations or appeals when requests are postponed or denied, using documentation that supports medical necessity.
• Stay informed on changing payer rules, regulatory expectations, and authorization workflows while protecting patient confidentiality at all times.
Qualifications:
• High school diploma or equivalent required.• At least 2 years of recent experience handling insurance authorizations in a hospital, clinic, medical group, or similar healthcare setting.
• Working knowledge of insurance follow-up, preauthorization processes, medical billing, patient accounting, and medical collections.
• Familiarity with commercial plans, Medicare, Medicaid or Medi-Cal, and managed care benefit structures.
• Ability to verify eligibility, interpret coverage details, and identify payer-specific submission requirements.
• Strong computer proficiency, including experience with electronic medical records and Microsoft Office applications.
• Effective written and verbal communication skills with the ability to prioritize tasks and collaborate across departments.
• Spanish-English bilingual skills or an associate degree in healthcare administration or a related field is preferred.
Compensation
$25.00-$27.00 HourlyAbout Us
TalentMatch®
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