What are the responsibilities and job description for the Medical Authorization Specialist position at Hope Fertility?
About Us
Hope Fertility is a patient-centered fertility practice dedicated to providing compassionate, high-quality reproductive care. Our team is committed to supporting patients throughout their journey with professionalism, empathy, and excellence. We are seeking a detail-oriented Medical Authorization Specialist to join our administrative team and help ensure seamless coordination of patient services.
Position Summary
The Medical Authorization Specialist is responsible for obtaining, tracking, and managing insurance authorizations for all clinical services, diagnostics, surgeries, and medications. This role works closely with clinical staff, billing, and patients to ensure services are approved and documented accurately and in a timely manner.
Key Responsibilities
- Obtain prior authorizations for procedures, imaging, labs, medications, and fertility-related treatments.
- Verify insurance eligibility, benefits, and coverage limitations.
- Communicate with insurance companies through phone calls, online portals, and written correspondence.
- Document all authorization details accurately in the EMR system.
- Notify patients of coverage, out-of-pocket costs, and any authorization requirements.
- Work closely with nurses, providers, and scheduling staff to coordinate timely approvals.
- Track pending, approved, and denied authorizations and follow up as needed.
- Assist with appeals, denials, and medical necessity documentation.
- Maintain strict compliance with HIPAA and insurance guidelines.
- Collaborate with billing staff to reduce claim denials related to authorization issues.
Qualifications Required
- High school diploma or equivalent.
- 1–2 years of experience in medical authorizations, prior authorizations, or medical billing.
- Strong understanding of insurance plans, prior authorization processes, and coverage rules.
- Familiarity with medical terminology, CPT codes, and ICD-10 coding.
- Excellent verbal and written communication skills.
- Strong attention to detail, time management, and follow-up skills.
- Ability to multitask in a fast-paced, patient-focused environment.
Preferred
- Experience in fertility, OB/GYN, or specialty medical practice.
- Experience using EMR systems (nAble or similar).
- Bilingual (English/Spanish) is a plus.
Skills & Competencies
- Strong organizational skills and accuracy in documentation
- Professional communication and customer service
- Problem-solving and critical thinking
- Ability to work independently and collaboratively
- Respectful handling of confidential patient information
Working Conditions
- Full-time onsite position
- Office-based environment involving frequent phone and computer work
- Interaction with patients, clinical teams, and insurance companies
Pay: $22.00 - $25.00 per hour
Expected hours: 36.5 per week
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
Salary : $22 - $25