Authorization Specialist

Authorization Specialist

Regional West Medical Center is seeking an Authorization Specialist to support timely, accurate prior authorization for patient services. This role is responsible for obtaining authorizations for surgeries, diagnostic and cardiac imaging, procedures, prescription medications, VA services, select durable medical equipment, and outside referrals.

The Authorization Specialist plays a key role in ensuring services are approved, properly documented, and aligned with payer requirements—supporting seamless patient care and revenue integrity.

Education

• High school diploma or equivalent required

Experience & Skills

• Two or more years of healthcare experience preferred
• Knowledge of insurance processes and medical terminology preferred
• Strong attention to detail and accuracy
• Ability to multitask and prioritize in a fast-paced environment
• Basic computer skills and comfort with electronic health records
• Excellent customer service, communication, and problem-solving skills
• Commitment to compliance, confidentiality, and patient-centered care

Key Responsibilities

• Obtain prior authorizations for surgeries, diagnostic imaging, procedures, medications, VA services, DME, and referrals
• Receive and process orders via the electronic health record or fax according to priority status
• Verify patient insurance eligibility and benefits
• Initiate authorizations through payer portals, phone, or fax, providing required clinical documentation
• Document authorizations, approvals, denials, appeals, and communications in the electronic health record per protocol
• Follow Prior Authorization policies, workflows, and quality metrics
• Identify and resolve authorization discrepancies promptly
• Coordinate with providers, clinical staff, and internal teams to ensure services align with approved authorizations
• Maintain confidentiality and comply with HIPAA and organizational policies
• Adapt to changing workflows and departmental needs

Why Regional West

• Tuition reimbursement and professional development opportunities
• Competitive compensation and comprehensive benefits
• Collaborative team focused on Mission, Values and Vision

A conditional job offer is contingent upon successfully passing a pre-employment drug test and background checks. A Physical Capacity Profile may be required for some positions.