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SP
Southwest Pain Center
Authorizations Clerk
Entry-Level JobVerifiedNo experience needed
Career Insights for Eligibility Specialist
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Scorecard
Based on New Mexico data
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What they do
An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
$49,902 / year median in New Mexico
+18% projected growth
Job Description
The Authorization Clerk is responsible for obtaining timely insurance authorizations for medical imaging, prescription medications, office visits, and pain management procedures. This role works closely with providers, insurance companies, patients, and clinical staff to ensure timely approvals, accurate documentation, and continuity of patient care while maintaining compliance with HIPAA and payer requirements. Essential Duties & Responsibilities Process and obtain prior authorizations for imaging, medications, office visits, and procedures. Submit authorization requests through payer portals (e.g., Availity, Cohere, eviCore, CoverMyMeds, Carelon). Verify insurance eligibility, benefits, and coverage using the EHR. Review clinical documentation to ensure complete and accurate submissions. Monitor authorization status and follow up with insurance carriers as needed. Communicate approvals, denials, and additional documentation requests to providers and staff. Initiate appeals and peer-to-peer reviews when appropriate. Maintain accurate authorization records, patient demographics, and insurance information in the EHR. Collaborate with clinical, scheduling, and billing teams to support patient care. Answer phones, assist patients, and perform other administrative duties as assigned. Maintain compliance with HIPAA and organizational policies. Qualifications Previous medical office or healthcare experience preferred. Knowledge of insurance verification, prior authorizations, and managed care. Familiarity with EHR systems, medical terminology, CPT, ICD-9, and ICD-10 coding. Experience with payer authorization portals preferred. Proficiency in Microsoft Office and strong organizational, communication, and customer service skills. Ability to manage multiple priorities in a fast-paced healthcare environment.