Insurance Verification & Authorization Specialist

• Verify patient insurance eligibility and benefits using payer portals and insurance carriers
• Confirm coverage details including copays, deductibles, coinsurance, and service limitations
• Review patient demographic and insurance information and make corrections within the practice management system as needed
• Ensure insurance verification is completed accurately and within required timelines prior to scheduled services

Prior Authorizations and Referrals

• Obtain prior authorizations and referrals when required by payer guidelines for scheduled services, procedures, or testing
• Ensure all required information for authorization requests is available, including CPT codes, diagnosis codes, and supporting documentation
• Track authorization requests and follow up with payers to ensure approval prior to the date of service
• Confirm scheduled services have valid authorization when required by payer and procedure

Patient Financial Responsibility

• Calculate estimated patient responsibility based on verified benefits and payer guidelines
• Communicate expected out-of-pocket costs to patients when appropriate prior to services
• Refer uninsured or underinsured patients to the Billing team for assistance or payment arrangements when needed

Coordination with Internal Teams

• Collaborate with Scheduling, Front Desk, and Clinical Operations to ensure patients are properly cleared for scheduled services
• Communicate authorization requirements, missing documentation, or insurance issues to appropriate staff
• Assist internal teams with insurance-related questions that may impact scheduling or patient care

Documentation

• Document verification results, authorization details, and payer communications within the practice management system
• Maintain accurate records of verification and authorization activity
• Ensure proper tracking of authorization approvals and expiration dates

• Knowledge of commercial, Medicare, and Medicaid insurance guidelines
• Familiarity with payer portals and insurance carrier websites
• Strong attention to detail and organizational skills
• Excellent written and verbal communication skills
• Ability to prioritize and manage multiple workflows and deadlines
• Ability to work independently while collaborating with a team in a fast-paced environment

Required Education and Experience

• High school diploma or equivalent required
• Healthcare, hospital, or medical office experience
• Familiarity with insurance verification, eligibility checks, or authorization workflows
• Experience working with EHR or practice management systems (NextGen, Athena, Epic, or similar)

Preferred Experience

• 1+ years of insurance verification or authorization experience in a healthcare setting
• Working knowledge of CPT and ICD-10 codes
• Experience working with payer portals for eligibility and authorization requests