Authorization Specialist

Job Summary

To support pediatric patients, the full-time Authorization Specialist will obtain prior authorizations and verify insurance coverage for various services, working remotely after an initial onsite training period.

Key responsibilities

• Secure prior authorizations for a variety of pediatric services and verify insurance eligibility and benefits
• Gather and review necessary clinical documentation to ensure compliance with payer medical necessity requirements
• Coordinate with clinical teams to expedite authorizations and communicate denied authorizations to initiate appeals

Required qualifications

• High school diploma or equivalent required; associate degree or healthcare certification preferred
• Minimum 1 year of experience in a Clinical, Revenue Cycle, Patient Access, or Insurance role related to prior authorization or insurance verification
• Experience with pediatric healthcare access roles preferred
• Knowledge of medical terminology, CPT/ICD-10 codes, and pediatric insurance benefits
• Familiarity with pediatric insurance policies, including Medicaid and managed care plans preferred