Authorization and Pre-Registration Specialist - On Site

Responsibilities and Duties:

Insurance Verification & Eligibility

• Verify patient insurance coverage and benefits before inpatient admissions or outpatient procedures.
• Confirm details such as policy status, copays, deductibles, and service coverage.
• Contact patients ahead of scheduled services to verify demographics and insurance information

Authorization Requests

• Check and verify outpatient Authorizations and submit prior authorization requests for inpatient insurance payers (Medicare, Medicaid, HMO, PPO).
• Ensure that all required data elements (CPT codes, diagnosis codes, clinical documentation) are included.
• Handle both elective and urgent/emergent inpatient admissions and outpatient surgical/day care procedures.

Follow-Up & Case Management

• Track pending authorizations and follow up with insurers to secure timely approvals.
• Escalate cases with potential financial clearance risks to management.
• Maintain accurate records of authorization status for each patient encounter.

Communication & Coordination

• Act as a liaison between patients, providers, and insurance companies.
• Answer incoming calls related to pre-authorization support and provide case handling.
• Coordinate with scheduling staff to ensure services are not performed without proper authorization.

Compliance & Documentation

• Ensure compliance with payer requirements and hospital/clinic financial clearance programs.
• Document all authorization activities in patient records and billing systems.
• Maintain tracking system and follow up on pending authorizations
• Support revenue cycle integrity by preventing claim denials due to missing authorizations.
• Verifies physician order for testing and contacts patient to preregister
• Performs other duties as assigned

Qualifications:

Education & Experience:

• 1-2 Years in a Healthcare environment
• Basic understanding of insurance authorization process
• Experience in Patient Access or Billing
• Strong Insurance knowledge
• Basic understanding of medical terminology

Skills & Competencies:

• Use of various insurance portals
• Knowledge of each individual insurance company’s rules and regulations
• Works as a vital team member with good time management skills and tasking important items
• Work independently requiring a minimum of detailed supervision and guidance
• Responsible for maintaining own individual case load

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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