About the Role
The specialist is responsible for verifying patient insurance eligibility and securing prior authorizations for treatments and procedures, ensuring timely approvals and accurate documentation within healthcare regulations.
Responsibilities
- Confirm patient insurance coverage details before appointments
- Initiate and track prior authorization requests for medical services
- Communicate with insurance providers to resolve coverage questions
- Maintain accurate records of verification and authorization outcomes
- Follow up on pending authorizations to prevent treatment delays
- Ensure compliance with payer-specific requirements and policies
- Update electronic health records with insurance and authorization status
- Collaborate with clinical staff to coordinate care timelines
- Respond to patient inquiries about insurance eligibility
- Identify and escalate coverage denials for review
- Process referrals when required by insurance plans
- Monitor authorization expiration dates and renew as needed
- Adhere to HIPAA and patient privacy standards
- Utilize practice management systems for documentation
- Support billing accuracy by verifying coverage upfront
- Stay current with changes in insurance plan policies
- Prepare necessary documentation for appeals processes
- Coordinate with scheduling to confirm service eligibility
- Minimize claim rejections through proactive verification
- Assist in training new staff on insurance procedures
- Maintain organized tracking of authorization case statuses
- Resolve discrepancies between expected and actual coverage
- Ensure timely submission of required clinical information
- Support operational efficiency by reducing authorization delays
- Contribute to audit readiness with complete documentation
Compensation
Competitive hourly wage with benefits
Work Arrangement
Hybrid
Team
Collaborative outpatient care environment
Work Environment
- Fast-paced outpatient setting with structured workflows
- Hybrid schedule combining office and remote work
- Regular interaction with clinical and administrative teams
- Use of secure digital platforms for patient data
Performance Expectations
- Meet daily targets for verification and authorization completion
- Maintain low error rate in insurance data entry
- Respond to requests within established timeframes
- Contribute to reducing claim denial rates
Not available
