Authorizations Representative

Location: REMOTE

Candidate MUST be located in one of the following states: AR, AZ, CA, CO, DE, FL, GA, IA, ID, IL, KY, MD, MI, MN, MO, MT, NC, ND, NM, NV, NY, OK, OR, RI, SD, TN, TX, VA, WA, WI, WY

Schedule: Full time (M-Fr 8am-4:30pm PST)

Pay: $21/hr

Position Summary

The Authorization Representative is responsible for obtaining, verifying, and documenting insurance authorizations and pre-certifications for medical procedures, services, or medications. This role ensures compliance with payer requirements, prevents claim denials, and supports efficient patient access to care.

Key Responsibilities

Insurance Verification & Authorization

• Secure prior authorizations and pre-certifications from insurance companies within required timeframes.
• Review medical necessity guidelines and payer policies to determine required documentation.
• Communicate with providers, clinical staff, and insurance carriers to obtain required details for authorization approval.
  
  

Documentation & Data Entry

• Accurately document authorization numbers, effective dates, status updates, and payer information in electronic health record (EHR) or practice management systems.
• Maintain organized and compliant records according to HIPAA standards..
  
  

Communication & Coordination

• Provide updates to scheduling, billing, and clinical teams regarding authorization status.
• Collaborate with clinical teams to support appeals or additional documentation requests.
  
  

Compliance & Quality Assurance

• Adhere to federal, state, and payer-specific regulations.
• Monitor policy changes from insurance carriers and notify internal teams as needed.
• Assist in resolving claim denials related to missing or incorrect authorizations.
  
  

Required

Skills & Qualifications:

• High school diploma or equivalent (some employers prefer an associate degree in healthcare administration or related field).
• Experience in healthcare authorization, medical billing, patient access, or insurance verification.
• Strong understanding of medical terminology, CPT/ICD-10 codes, and insurance regulations.
• Excellent communication, organization, and problem-solving skills.
• Proficiency with EHR systems, payer portals, and standard office software.
  
  

Preferred

• Experience working with multiple insurance payers (Medicare, Medicaid, commercial plans).
  
  

Core Competencies

• Attention to detail
• Ability to work in a fast-paced environment
• Time management
• Critical thinking and decision-making