Medical Authorization Specialist

We are seeking Medical Authorization Specialist to focus on verifying insurance eligibility, managing prior/pre-authorization requests, and ensuring accurate medical billing. The specialist will calculate revenue and allowable amounts, submit compliant billing to government and private insurance payers, and coordinate with the Sales Team to collect required documentation before invoicing. The role requires strong knowledge of insurance guidelines, coordination of benefits, and healthcare compliance.

Key Responsibilities

• Verify insurance eligibility and follow coordination of benefits (COB) guidelines to ensure accurate coverage determination.
• Prepare and fax accurate Pre-Authorization Request Letters, ensuring completeness and compliance with payer requirements.
• Determine revenue amounts based on allowable charges, benefits, unit pricing, payer guidelines, copayments, and contract pricing.
• Submit accurate billing to Government entities and private insurance payers in compliance with Federal, State, and insurance-specific regulations.
• Obtain and track supporting documentation from the Sales Team to ensure all required documents are received prior to invoicing.
• Maintain compliance with healthcare billing standards while ensuring accuracy, timeliness, and documentation integrity.

Required Skills & Keywords

• Insurance Eligibility Verification.
• Pre-Authorization / Prior Authorization.
• Coordination of Benefits (COB).
• Medical Billing & Revenue Calculation.
• Government and Commercial Payer Billing.
• HIPAA, Federal and State Compliance.
• Documentation Management & Invoicing Support.

About BrickRed Systems:

BrickRed Systems is a global leader in next-generation technology, consulting, and business process service companies. We enable clients to navigate their digital transformation. BrickRed Systems delivers a range of consulting services to our clients across multiple industries around the world. Our practices employ highly skilled and experienced individuals with a client-centric passion for innovation and delivery excellence. With ISO 27001 and ISO 9001 certification and over a decade of experience in managing the systems and workings of global enterprises, we harness the power of cognitive computing hyper-automation, robotics, cloud, analytics, and emerging technologies to help our clients adapt to the digital world and make them successful. Our always-on learning agenda drives their continuous improvement through building and transferring digital skills, expertise, and ideas from our innovation ecosystem.