Authorization Specialist Position Available In Miami-Dade, Florida

Authorization Specialist South Florida Pediatric Urology LLP Miami, FL Job Title:

Authorization Specialist –

Surgical and Imaging Services Department:

Revenue Cycle /

Pre-Authorization Reports To:

Practice Administrator Location:

Miami, Florida Job Type:

Full Time __ __ __ __ __ __ __ __ __ __

Position Summary:

The Authorization Specialist is responsible for securing prior authorizations and verifying insurance benefits for scheduled surgical procedures. This role ensures that all surgical services are authorized in accordance with payer requirements and that patients are informed of their coverage and financial responsibilities prior to the procedure date. The Authorization Specialist plays a vital role in the revenue cycle by minimizing denials, supporting clinical operations, and enhancing the patient’s experience. __ __ __ __ __ __ __ __ __ __

Key Responsibilities:

Obtain prior authorizations for surgical procedures, diagnostic tests, and ancillary services from insurance payers. Verify patient insurance benefits and eligibility for scheduled surgeries, including coverage limitations, co-pays, deductibles, and out-of-pocket costs. Communicate with insurance companies, physician offices, and surgical schedulers to gather necessary documentation and ensure timely approvals. Document all authorization and benefit information in the Electronic Medical Record (EMR) or Practice Management System accurately and promptly. Track and follow up on pending authorizations to avoid delays or cancellations of services. Notify patients of authorization status and estimated out-of-pocket costs and assist with questions regarding insurance coverage. Coordinate with billing and clinical staff to resolve discrepancies or missing information related to authorizations. Maintain up-to-date knowledge of payer guidelines, authorization processes, and policy changes. Update authorizations when surgical codes are changed on the same day of surgery. Meet departmental performance standards including accuracy, productivity, and turnaround time. __ __ __ __ __ __ __ __ __ __

Qualifications:

Education:

High school diploma or equivalent required. Associate’s degree or medical administrative training preferred.

Experience:

Minimum 1-2 years of experience in a healthcare setting, preferably in a surgical or pre-authorization role. Familiarity with commercial insurance plans, Medicare, Medicaid, and managed care authorization processes.

Skills:

Strong understanding of medical terminology, CPT/ICD-10 coding, and surgical procedures. Proficiency in EMR systems and insurance portals. Excellent communication and customer service skills. High attention to detail and ability to manage multiple tasks and deadlines. Problem-solving mindset with the ability to work independently and as part of a team. __ __ __ __ __ __ __ __ __ __

Preferred:

Certified Medical Administrative Assistant (CMAA) or Certified Professional Coder (CPC) is a plus. __ __ __ __ __ __ __ __ __ __

Working Conditions:

Office May require occasional extended hours to meet scheduling demands.

Job Type:

Full-time