Insurance Authorization Specialist Job Summary
The Insurance Authorization Specialist is responsible for obtaining timely insurance authorizations and verifying benefits for Interventional Radiology procedures performed across multiple office locations. This role serves as a liaison between providers, patients, insurance companies, and referring physicians to ensure all required authorizations, medical necessity documentation, and payer requirements are met before services are rendered. The specialist plays a critical role in minimizing claim denials, preventing scheduling delays, and supporting the practice's revenue cycle.
Essential Duties and Responsibilities
- Obtain prior authorizations and pre-certifications for Interventional Radiology and vascular procedures.
- Verify patient insurance eligibility, benefits, deductibles, co-insurance, and out-of-pocket responsibilities.
- Review provider documentation to ensure medical necessity supports authorization requests.
- Submit clinical documentation to insurance carriers through payer portals, fax, or phone.
- Monitor authorization status and follow up with payers to ensure timely approval.
- Coordinate peer-to-peer reviews between providers and insurance medical directors when required.
- Communicate authorization status, denials, and required documentation with physicians, clinical staff, scheduling personnel, and patients.
- Process appeals and reconsideration requests for denied authorizations.
- Maintain accurate documentation of authorization numbers, expiration dates, payer requirements, and communications within the electronic medical record (EMR).
- Collaborate with scheduling staff to prevent delays or cancellations due to incomplete authorizations.
- Stay current with payer policies, Medicare guidelines, commercial insurance requirements, and medical necessity criteria.
- Assist with revenue cycle initiatives by identifying authorization trends and opportunities to reduce denials.
- Maintain confidentiality and comply with HIPAA and all applicable federal and state regulations.
Qualifications
- High school diploma or equivalent required; associate degree preferred.
- Minimum of 2 years of insurance authorization, medical billing, revenue cycle, or healthcare administrative experience preferred.
- Prior experience in Interventional Radiology, vascular surgery or another procedural specialty strongly preferred.
- Working knowledge of Medicare, Medicaid, and commercial insurance plans.
- Experience with electronic medical records (EMR) and practice management software.
- Strong understanding of medical terminology, CPT, ICD-10-CM, and payer authorization requirements.
- Excellent communication, organizational, and problem-solving skills.
- Ability to manage multiple priorities in a fast-paced, multi-location medical practice.
Knowledge, Skills, and Abilities
- Strong attention to detail and accuracy.
- Excellent time management and follow-up skills.
- Ability to work independently while collaborating with providers and clinical staff.
- Professional telephone etiquette and customer service skills.
- Proficiency in Microsoft Office applications and payer web portals.
- Ability to maintain strict patient confidentiality.
Work Environment
This position is primarily office-based and may support multiple clinic locations. Daily responsibilities include extensive computer use, telephone communication, interaction with patients, providers, insurance carriers, and referring offices, and occasional travel between practice locations as needed.
Insurance Authorization Specialist Requirements and Qualifications
- 1+ years of experience working for a healthcare practice
- Familiar with medical terminology, CPT, ICD10 and insurance
- Excellent communication and organizational skills
- Spanish and Creole preferred
Job Type: Full-time
Pay: $18.00 - $21.50 per hour
Work Location: In person
