Medical Authorizations Specialist

A well-established healthcare organization iis searching for a detail-oriented and organized Medical Authorizations Specialist to support healthcare operations by obtaining and managing insurance authorizations for patient services. This role is ideal for someone with strong knowledge of insurance processes, excellent communication skills, and the ability to work efficiently in a fast-paced healthcare environment.

RESPONSIBILITIES AND DUTIES:

• Obtain and process prior authorizations, referrals, and pre-certifications for medical procedures, diagnostic testing, specialty services, and treatments
• Verify patient insurance eligibility, benefits, coverage requirements, and authorization needs
• Review clinical documentation to ensure completeness and accuracy for authorization submissions
• Communicate with insurance companies, healthcare providers, and patients regarding authorization status and requirements
• Track and monitor authorization requests to ensure timely approvals and prevent delays in patient care
• Follow up on pending, denied, or incomplete authorization requests and initiate appeals when appropriate
• Document authorization activities, approvals, denials, and communications within the electronic health record (EHR) system
• Maintain accurate patient demographic and insurance information
• Educate patients regarding insurance requirements, authorization processes, and financial responsibilities as appropriate
• Collaborate with physicians, clinical staff, scheduling teams, and insurance representatives to facilitate patient care
• Identify and resolve authorization-related issues while maintaining a high level of customer service
• Ensure compliance with HIPAA regulations and organizational confidentiality standards
• Maintain knowledge of payer guidelines, insurance regulations, and authorization requirements
• Participate in training and professional development activities to remain current with healthcare industry standards and best practices
• Consistently meet departmental productivity, quality, and turnaround time goals
• Adhere to all organizational policies, procedures, and practices
• Perform all other duties as assigned

REQUIREMENTS AND QUALIFICATIONS:

• High school diploma or GED required
• Must be able to provide transcripts
• Minimum of one (1) year of experience with insurance authorizations, referrals, or prior authorizations in a healthcare setting required
• Experience verifying insurance eligibility and benefits required
• Experience working with electronic health records (EHR) systems preferred
• Knowledge of medical terminology preferred
• Strong understanding of insurance plans, payer requirements, and authorization processes
• Excellent written, verbal, and interpersonal communication skills
• Strong organizational skills with exceptional attention to detail
• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment
• Ability to work independently and collaboratively as part of a healthcare team
• Applicants may be subject to a background check.*
• A pre-employment drug screening may be required as a condition of employment.

*A conviction does not automatically disqualify you from employment. We will consider factors such as the timing, nature, and seriousness of any offense, as well as evidence of rehabilitation.

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Sparrow Company Executive Search & Staffing is an Equal Opportunity Employer.