Medical Insurance Authorization Specialist

Healthcare Insurance Prior Authorization Specialist

Employment Type: Full-Time

Position Overview

We are seeking a detail-oriented and highly organized Healthcare Insurance Prior Authorization Specialist to join our team. This position plays a critical role in ensuring that patients receive timely access to care while helping the organization maximize appropriate reimbursement from medical insurance providers.

The successful candidate will serve as a key gateway between clinical services, insurance companies, and the internal care team, using their knowledge of medical insurance benefits, authorization requirements, and payer processes to facilitate approvals and minimize reimbursement delays.

This role requires strong attention to detail, sound judgment, excellent communication skills, and the ability to work confidently with confidential medical and insurance information.

Key Responsibilities

• Verify medical authorization requirements.
• Initiate, submit, track, and follow up on prior authorizations for medical services and treatments.
• Review confidential patient and medical records to identify and organize documentation needed to support authorization requests.
• Evaluate authorization requirements and ensure submissions contain appropriate clinical and supporting documentation to optimize the likelihood of approval.
• Communicate with insurance companies, utilization management departments, medical offices, and other healthcare entities regarding authorization status and requirements.
• Identify missing information or documentation that may delay authorization or reimbursement and proactively work to resolve issues.
• Maintain accurate records of authorization requests, approvals, denials, pending requests, and follow-up activities.
• Monitor authorization timelines and proactively follow up on outstanding requests to prevent delays in patient care or reimbursement.
• Requests for additional information, and authorization-related appeals as needed.
• Collaborate closely with internal team to ensure authorization and reimbursement requirements are met.
• Protect patient privacy and maintain strict confidentiality in accordance with HIPAA and organizational policies.
• Stay informed regarding changes in insurance policies, payer requirements, authorization guidelines, and healthcare reimbursement practices.
• Perform additional administrative and operational duties as needed to support the team and improve overall workflow.

Qualifications

• Prior experience in medical insurance prior authorization, utilization management preferred.
• Working knowledge of medical insurance plans, benefits, payer requirements, and authorization processes.
• Experience reviewing medical records and clinical documentation is strongly preferred.
• Familiarity with Medicare, Medicaid, commercial insurance, or other healthcare payers is a plus.
• Strong attention to detail and ability to identify missing or insufficient documentation.
• Excellent organizational and time-management skills.
• Strong written and verbal communication skills.
• Ability to communicate professionally and effectively with insurance companies, healthcare providers, patients, and internal team members.
• Ability to handle sensitive and confidential information with discretion.
• Comfortable working independently while also functioning as a collaborative member of a healthcare team.
• Proficiency with electronic medical records, insurance portals, Microsoft Office, and other healthcare-related software is preferred.

What Makes This Position Important

This position is a critical component of the organization’s ability to secure timely insurance authorization, facilitate patient access to care, and optimize appropriate reimbursement. The ideal candidate understands that successful authorization requires more than simply submitting paperwork, it requires careful review, attention to payer requirements, proactive follow-up, and effective coordination across multiple parties.

If you are knowledgeable about healthcare insurance and enjoy solving problems, navigating payer requirements, and helping a team achieve successful outcomes, we would love to hear from you.

Pay: $22.00 - $24.00 per hour

Expected hours: 36.0 per week

Benefits:

• 401(k)
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $22 - $24