Insurance Authorization Specialist II
Core
Obtaining prior authorizations for elective procedures, services, and tests to financially clear patients before care is rendered.
Role type
Insurance Authorization Specialist
Builds
Financial clearance for surgeries, tests, and referrals
Domain
Healthcare administration / Insurance billing
Required skills
Medical terminology, ICD-10 coding, CPT coding, Insurance guidelines, Epic system navigation, Payor policy interpretation
Preferred skills
Third-party payor knowledge, Denial management, Retro-authorization processes
Responsibilities
Identify patients requiring pre-certification or pre-authorization; Contact insurance companies to determine eligibility and benefits; Obtain authorization for referrals, tests, and surgeries within expected timeframes; Review and interpret medical record documentation to answer clinical questions; Follow up on submitted authorization requests and appeals; Notify scheduling and physicians of unauthorized cases; Assist Patient Financial Services with denial management issues.
Seniority
Entry-level to Mid-level, hands-on IC
