Authorization Specialist

The Authorization Specialist is responsible for obtaining prior authorizations, precertifications, and other payer-required approvals for scheduled services and procedures. This position serves as a liaison between providers, clinical staff, scheduling teams, patients, and insurance payers to gather required information, submit authorization requests, follow up on pending approvals, and communicate authorization status to support timely authorization decisions and minimize delays in care. The Authorization Specialist ensures authorization activity is accurately documented and that potential delays, denials, or issues are communicated to appropriate stakeholders. This position works collaboratively with internal departments and external payer organizations to support financial clearance and ensure compliance with payer requirements.

Minimum Qualifications

• Experience in healthcare, insurance verification, prior authorization, patient access, revenue cycle, or a related field preferred.
• High School Diploma or GED preferred.
• Knowledge of medical terminology, healthcare insurance plans, and payer authorization requirements preferred.
• Knowledge of prior authorization processes and reimbursement practices preferred.
• Strong verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities and meet established deadlines.
• Ability to work effectively with patients, providers, clinical staff, and payer representatives.
• Proficiency with computer systems and standard office software applications.
• Experience with Epic or similar electronic health record systems preferred.

Key Responsibilities

• Reviews scheduled services and procedures to determine authorization, precertification, or other payer approval requirements.
• Obtains prior authorizations, precertifications, and other payer-required approvals for scheduled services and procedures.
• Verifies payer requirements, coverage guidelines, clinical documentation needs, and submission processes.
• Communicates with insurance carriers, provider offices, clinical departments, scheduling teams, and patients as needed to obtain information required for authorization requests.
• Submits authorization requests with accurate patient, provider, service, diagnosis, procedure, and supporting clinical information.
• Monitors authorization work queues and follows up on pending requests to support timely financial clearance.
• Tracks authorization status, payer determinations, approval numbers, effective dates, and related information in designated systems.
• Communicates authorization approvals, delays, denials, missing information, or other issues to appropriate stakeholders in a timely manner.
• Escalates complex authorization issues, payer delays, urgent requests, or potential barriers to the appropriate supervisor or department contact.
• Assists with authorization-related denials, payer inquiries, and requests for additional information.
• Maintains current knowledge of payer authorization requirements, medical necessity guidelines, coverage policies, and workflow changes.
• Ensures authorization processes are completed in accordance with payer requirements, regulatory standards, and organizational policies.
• Supports denial prevention efforts by ensuring authorization accuracy, timely follow-up, and complete documentation.
Participates in process improvement activities to enhance authorization efficiency, accuracy, and service quality.