Authorization Specialist

Job Summary

Seeking a detail-oriented Authorization Specialist, the full-time remote position will manage prior authorizations for various services, ensuring compliance with insurance requirements and addressing authorization denials.

Key responsibilities

• Obtain and track authorizations for new and existing patients according to insurance policies and medical guidelines
• Initiate Peer to Peer communications with payers and collaborate with clinical staff to secure Medical Necessity letters
• Monitor authorization work queues, verify approval letters for accuracy, and troubleshoot authorization denials

Required qualifications

• Associate degree preferred, with certification in CCS, CCS-P, CPC, or specialty coding preferred
• Minimum of three years' experience in a healthcare environment, with surgical authorization experience required
• Strong understanding of HIPAA laws, managed care, and third-party payer benefits
• Proficient in Microsoft Office applications and experience with EPIC or comparable EMR systems
• Knowledge of ICD-9 and ICD-10 coding and experience in reviewing medical records for National and Local Coverage Determinations