Insurance Verification & Authorization Specialist

Job DetailsJob Summary The Insurance Verification & Authorization Specialist is responsible for verifying patient insurance coverage and benefits and securing all required prior authorizations prior to scheduled appointments and procedures. This role ensures accurate eligibility and authorization data to support timely reimbursement, minimize claim denials, and maintain compliant, efficient front-end revenue cycle operations. Key Responsibilities Verify insurance eligibility and benefits for scheduled patients via payer portals, clearinghouses, and phone contact with insurance carriers Confirm coverage details including copays, deductibles, coinsurance, out-of-pocket maximums, and authorization/referral requirements Identify payer-specific prior authorization requirements for urology procedures and initiate requests proactively Submit and track prior authorization requests through payer portals, fax, or phone, ensuring timely turnaround ahead of scheduled dates of service Follow up on pending authorizations, elevate delays, and resolve payer denials or requests for additional clinical documentation Obtain and document peer-to-peer review scheduling when authorizations are initially denied Accurately document verification and authorization status in the practice management/EHR system Communicate coverage gaps, authorization status, or denial risk to scheduling, clinical, and billing staff in a timely manner Calculate and communicate estimated patient out-of-pocket costs for procedures Maintain current knowledge of payer-specific medical necessity and authorization criteria (Medicare, Medicaid, Commercial and Advantage Plans) Support denial prevention through accurate, complete front-end verification and authorization data Meet productivity and accuracy standards for verification and authorization turnaround time Escalate complex, high-dollar, or unresolved authorization issues appropriately QualificationsQualifications High school diploma or equivalent required; associate degree or healthcare-related certification preferred 3-5 years of experience in insurance verification, prior authorization, medical billing, or patient access, preferably in a specialty physician practice Working knowledge of payer authorization requirements across HMO, PPO, Medicare, and Medicaid plans Familiarity with CPT/ICD-10 coding as it relates to medical necessity and authorization determination Experience with EHR/practice management systems Strong attention to detail, follow-up discipline, and organizational skills Excellent communication skills for interacting with patients, payers, and internal teams Preferred Prior experience in urology or a surgical specialty Experience with peer-to-peer review coordination #J-18808-Ljbffr