Job Summary We are seeking a motivated and detail-oriented Authorization Specialist to join our dynamic healthcare team. In this vital role, you will be responsible for obtaining and managing prior authorizations, verifying insurance benefits, and ensuring all supporting documentation is complete and managing the authorization process for home care services, ensuring timely approval of patient requests while maintaining compliance with all relevant regulations. Your expertise will help streamline patient care, optimize insurance interactions, and uphold the highest standards of confidentiality and accuracy. If you thrive in a fast-paced environment and are passionate about facilitating quality healthcare access, this is the perfect opportunity to make a meaningful impact. Responsibilities Review patient requests for medical or dental procedures, verifying insurance coverage and eligibility through managed care systems. Obtain prior authorization from insurance companies by submitting necessary documentation and following up to ensure approval is secured promptly. Collaborate with medical office staff, including physicians, dental practitioners, and administrative personnel, to gather required medical records, CPT (Current Procedural Terminology) codes, ICD (International Classification of Diseases) codes (ICD-9 and ICD-10), and supporting documentation. Ensure all authorizations comply with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and confidentiality. Maintain accurate records of authorization requests, approvals, denials, and related correspondence within medical records management systems. Communicate clearly with patients regarding their authorization status and assist with insurance verification processes to facilitate smooth service delivery. Stay updated on changes in insurance policies, coding standards, and healthcare regulations to ensure ongoing compliance. Assist in training new staff members on authorization procedures and best practices for managed care processes. Qualifications Proven experience in managed care environments or medical office settings, preferably with dental or outpatient clinics. Strong knowledge of medical terminology, insurance verification procedures, and medical coding. Familiarity with HIPAA regulations to ensure confidentiality of protected health information (PHI). Experience handling medical records management accurately and efficiently. Excellent communication skills to liaise effectively with insurance companies, healthcare providers, patients, and team members. Ability to multitask in a fast-paced environment while maintaining attention to detail. Office experience with proficiency in electronic health records (EHR) systems or similar platforms is highly desirable. Prior health care office experience is a plus but not required. Join us in delivering exceptional healthcare access by ensuring that authorization processes are seamless, compliant, and efficient!

Job Type:

Full-time Pay:

$16.00 - $21.00 per hour

Work Location:

In person