Authorization Specialist

Position Overview We are seeking a proactive, highly organized Patient Intake & Prior Authorization Specialist to manage the front-end patient onboarding and coverage approval process. In this dual-focus role, you will verify patient eligibility, register incoming referrals, secure insurance prior authorizations, and coordinate directly with clinical teams and third-party payers. Key Responsibilities Intake & Registration: Accurately collect and enter demographic, clinical, and insurance information for new and returning patients into the Electronic Health Record (EHR) system. Insurance Verification: Verify active coverage, copayments, coinsurance, deductibles, and network status across commercial plans, Medicare, and Medicaid. Prior Authorization Management: Prepare, submit, and track prior authorization requests for specialist consultations, procedures, diagnostic tests, and pharmaceuticals according to payer-specific criteria. Clinical Coordination: Collaborate with physicians, nurses, and medical assistants to obtain necessary clinical documentation, chart notes, and letters of medical necessity. Denial Resolution & Peer-to-Peer Support: Monitor pending authorization requests, identify root causes for initial coverage denials, assist in drafting appeals, and schedule peer-to-peer clinical reviews when needed. Patient Communication: Keep patients informed regarding the status of their authorizations, explain coverage limitations or out-of-pocket responsibilities clearly, and maintain compassionate customer service. Compliance & Recordkeeping: Adhere strictly to HIPAA guidelines, payer compliance timelines, and organizational protocols for document handling. Qualifications & Requirements Experience: 2+ years of experience in healthcare intake, patient access, prior authorization, or medical billing/scheduling. Insurance Knowledge: In-depth understanding of prior authorization workflows, payer portals (Availity, CoverMyMeds, payer-specific web portals), and medical terminology (ICD-10, CPT, and HCPCS codes). Systems Proficiency: Hands-on experience working with EHR/Practice Management platforms (e.g., Epic, Athenahealth, Cerner, or Kareo). Skills: Excellent communication and phone etiquette, strong attention to detail, and the ability to multitask in a fast-paced environment. Education: High school diploma or equivalent required; associate degree or relevant medical administrative certification preferred. What We Offer Competitive hourly rate /based on experience. Comprehensive medical, dental, and vision benefits. 401(k) starting January 2026 Paid time off (PTO) and paid holidays. Ongoing training and professional growth opportunities. #J-18808-Ljbffr violet health | Infusion Care