JOB TITLE: INSURANCE AUTHORIZATION SPECIALIST 

POSITION SUMMARY: 

The INSURANCE AUTHORIZATION SPECIALIST performs clerical functions for patient billing, including verification of insurance information and resolution of problems to ensure a clean billing process. Follows up on accounts that require further evaluation. Works with others in a team environment.

PRINCIPAL DUTIES AND RESPONSIBILITIES: 

• Monitors incoming clients gathering information needed to complete pre-authorization request.

• May assist in the verification patient’s insurance eligibility 

• Able to review patient insurance data and speak to family members regarding deductibles/copays/coinsurance when needed.

• Review chart documentation to ensure patient meets medical policy guidelines

• Obtain authorization via payer website or by phone and follow up regularly on pending cases

• Initiate appeals for denied authorizations

• Respond to clinic questions regarding payer medical policy guidelines

• Contact patients to discuss authorization status

• Responsible for obtaining pre- authorization after the verification process has been completed. Will also complete and maintain all upcoming treatment authorizations

•Communicating to the appropriate admin team when a peer-to-peer review is needed.

• Answers questions from patients, clerical staff, and insurance companies. 

• Works in conjunction with the admin team to ensure clean billing.

• Performs miscellaneous job-related duties as assigned. 

• Participates in educational activities and attends monthly staff meetings. 

• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations. 

• Assists in development and communication of insurance policies for key areas to improve accuracy and understanding of processes.

•Assist with patient filingwhen needed

QUALIFICATIONS & SKILLS: 

• Minimum of 1 year of relevant experience and/or training, or equivalent combination of education and experience. 

• Strong knowledge of administrative and clerical procedures. 

• Proficient in computers and relevant software applications and practice management technology. 

• Possession of strong problem-solving skills and sound judgment. 

• Ability to collaborate across departments and build effective relationships with internal and external customers to achieve goals. 

• Knowledge of customer service principles and practices. 

• Ability to achieve team goals while demonstrating organizational values and utilizing resources responsibly. 

• Ability to be proactive and take initiative.