Authorization Specialist | Insurance Verification

Authorization Specialist | Insurance Verification

Join a dedicated healthcare team in the heart of the Midwest region, where your role as an Authorization Specialist will be vital in ensuring patients receive timely and accurate insurance verification and prior authorization for medical procedures.

General Summary

As an Insurance Verification and Prior Authorization Team Member, you will be responsible for confirming patient eligibility, determining benefits, and securing prior authorizations before scheduled exams. Your work will support surgical, laboratory, and diagnostic imaging services by efficiently processing multiple requests while maintaining accuracy.

Essential Duties and Responsibilities

• Obtain or assist in obtaining prior authorizations/precertifications from insurance payers for various medical procedures.
• Manage multiple patient authorization requests simultaneously with precision.
• Document authorization decisions in clinical software following established policies.
• Communicate with insurance providers via phone and online portals to verify benefits and authorization status.
• Confirm member plan eligibility and benefits prior to processing requests.
• Utilize clinical knowledge and resources to support authorization processes.

Education

High school diploma or equivalent is required. Completion of a Registered Medical Assistant or Licensed Practical Nurse program is preferred.

Experience

At least one year of clinical experience in a healthcare setting is required. Experience with insurance verification and prior authorization processes is preferred. Familiarity with medical terminology and CPT & ICD-9/10 coding is advantageous.

Requirements

A valid Licensed Practical Nurse license from a compact state or an accredited Registered Medical Assistant certification is required if applicable. Strong communication skills, both verbal and written, are essential. Ability to maintain focus during repetitive tasks and to work in a standard office environment with occasional exposure to noise and other typical workplace conditions.