Authorization Specialist

Job Summary

Serving as a critical link between clinical care teams, insurance providers, and patients, the full-time Authorization Specialist will manage prior authorizations, verify insurance benefits, and ensure compliance with medical necessity criteria while working on-site in Bluffton, South Carolina.

Key responsibilities

• Secure required pre-authorizations and pre-certifications for diagnostic imaging, specialized procedures, and pharmaceuticals
• Verify patient insurance benefits and eligibility prior to scheduled appointments and treatments
• Review electronic health records to ensure clinical documentation meets insurance guidelines and medical necessity criteria

Required qualifications

• High School Diploma or GED
• Two years of experience in a medical office or referrals preferred
• Knowledge of medical office software for processing referrals and managing patient information
• Experience handling Protected Health Information (PHI)
• Familiarity with CPT and ICD-CM coding processes is preferred