Authorization & Insurance Specialist

Job Description

Job Description

Description:

With 65 years of service to the community as the premier imaging center in Tallahassee, we continue to grow and thrive. We are seeking superstars with a customer service mindset to join our team and share in our success.

Authorization & Insurance Specialist

Full-time (On-Site, Monday-Friday, 8am-5pm)

Tallahassee, FL

ESSENTIAL FUNCTIONS:

• Verify patient insurance eligibility, benefits, and coverage requirements prior to date of service, ensuring accuracy and completeness
• Review orders for completeness and obtain appropriate documentation to support authorization requests
• Obtain prior authorizations for imaging services in a timely and accurate manner, maintaining consistency and attention to detail
• Review and validate authorizations obtained by referring offices to ensure accuracy of patient demographics, insurance coverage, ordered exam, and authorization details; identify discrepancies and take appropriate action prior to the date of service
• Monitor assigned work queues to ensure authorizations are obtained prior to the date of service whenever possible and escalate cases with missing or pending authorizations to avoid delays or reschedules
• Prioritize time-sensitive exams and manage deadlines effectively in a fast-paced environment
• Coordinate with referring offices to obtain clinical documentation, corrected orders, or additional information required for authorization and resolve discrepancies as needed
• Investigate and resolve authorization-related issues, including denials, delays, or incomplete submissions, and follow through to resolution
• Communicate authorization status updates to scheduling teams and other departments in a timely and consistent manner
• Maintain accurate and up-to-date documentation within the system, ensuring data integrity and consistency
• Ensure all processes comply with payer requirements, HIPAA regulations, and organization policies, maintaining confidentiality and professionalism in all interactions
• Assist with coverage and workload distribution as needed to support team operations and maintain workflow continuity
• Perform other duties as assigned

EDUCATION: High school diploma or GED.

EXPERIENCE:

Minimum of three years of experience in healthcare insurance and/or prior authorizations.

Experience verifying insurance eligibility and benefits.

KNOWLEDGE:

Knowledge of insurance verification processes and patient financial responsibility.

Knowledge of prior authorization workflows and payor requirements.

Basic understanding of CPT/ICD-10 concepts.

Knowledge of HIPAA and patient confidentiality.

Knowledge of workflow and time management in a healthcare setting.

SKILLS:

Excellent organizational and time management abilities.

Attention to detail and accuracy.

Effective communication and interpersonal skills.

Skill in problem-solving and critical thinking.

Ability to manage multiple priorities in a fast-paced environment.

Proficiency in computer systems, including EMR/RIS platforms and Microsoft Office.

ABILITIES:

Ability to speak clearly and concisely.

Ability to read, understand, and follow oral, and written instruction.

Ability to sort and file materials correctly by alphabetic or numeric systems.

Ability to establish and maintain professional and effective working relationships with patients, employees, and the public.

PHYSICAL/MENTAL DEMANDS:

This position requires performing work in a standard office environment, with prolonged sitting and frequent use of a computer, keyboard, and telephone. The role involves frequent computer screen viewing, data entry, and document review, requiring close visual acuity. The individual must be able to communicate effectively, both verbally and in writing. Occasional standing, walking, bending, and reaching may be required. The position may involve lifting or moving light office materials (up to 10-15 pounds).

This position also requires the ability to work in a fast-paced, high-volume healthcare environment with frequent multitasking, prioritization, and attention to detail. The role requires the ability to manage deadlines, maintain accuracy under pressure, and communicate effectively with patients, staff, and referring offices. The individual must demonstrate sound judgment, problem-solving skills, adaptability, and professionalism while responding to workflow interruptions and changing operational demands.

ENVIRONMENTAL/WORKING CONDITIONS:

Work is performed in an office environment within a healthcare setting. Involves frequent telephone contact with staff, patients, and referring physician offices. Work is fast-paced and may be stressful at times with frequent interruptions, competing priorities and time-sensitive tasks. The position requires regular use of computers, phones, and other office equipment. The noise level is typically moderate. Adherence to organization policies, including confidentiality and HIPAA requirements as required.

EXPOSURE DETERMINATION TO BLOODBORNE PATHOGENS:

Category III: Classification in which employee has no occupational exposure to bloodborne pathogens.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.