Authorization Specialist I
Core
Ensures accuracy of insurance information and procures prior authorization and predetermination for scheduled patient appointments and inpatient admissions to prevent claim denials.
Role type
Authorization Specialist
Builds
Revenue cycle billing and collections functions
Domain
Healthcare administration / Insurance verification
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Insurance terminology, navigating insurance websites, medical billing knowledge, phone-based contact center skills, organizing and prioritizing work, detail orientation
Preferred skills
Benefits verification experience, pre-registration experience, post-secondary education
Technologies
Fax, copier, scanner, computer systems
Responsibilities
Monitors patient and referral queues to determine encounters requiring pre-registration or authorization. Evaluates physician referral and authorization requirements. Reviews clinical documentation for CPT/diagnosis code information. Coordinates with patients, referring physicians, and financial counselors to obtain information. Documents pertinent information in computer systems. Protects patient health information confidentiality.