Insurance Authorization Specialist

Insurance Authorization Specialist

Job Type: Full-Time

Work Hours: Monday to Friday, 9:00 AM to 6:00 PM Pacific Time, with a 1-hour break

Job Overview:

We are seeking an experienced Insurance Authorization Specialist with hands-on experience processing HMO authorizations and prior authorizations, both of which are required for this role. The ideal candidate will have a strong understanding of healthcare insurance processes and authorization requirements, with the ability to accurately prepare and submit requests, communicate with insurance providers, and follow up consistently to obtain timely approvals.

This role will manage authorization requests from initial verification through approval, denial, or resolution of outstanding requirements. The successful candidate will be highly organized, detail-oriented, and comfortable handling time-sensitive requests while maintaining accurate patient records and strict confidentiality. Candidates must have direct experience with HMO and prior authorization processes; medical billing experience alone is not sufficient.

Key Responsibilities:

Insurance Authorization

• Process insurance authorizations, HMO authorizations, and prior authorizations for medical services, procedures, medications, and diagnostic testing as required.
• Verify patient insurance eligibility, benefits, and authorization requirements.
• Determine whether prior authorization is required for requested services or treatments.
• Submit authorization requests through insurance portals, by phone, or through other designated channels.
• Gather and submit required clinical documentation, referrals, medical records, and supporting information.
• Monitor authorization requests and follow up with insurance companies to obtain approvals or resolve pending requests.
• Track authorization status, approval dates, expiration dates, authorization numbers, and other relevant information.
• Identify missing or incomplete information and coordinate with the appropriate clinical or administrative staff to obtain the required documentation.
• Follow up on denied, delayed, or incomplete authorization requests and assist with additional documentation or resubmission as needed.
• Communicate authorization requirements and status updates to providers, clinical staff, and other members of the healthcare team.
• Maintain accurate and up-to-date authorization records.

Patient and Administrative Support

• Communicate professionally with patients regarding insurance requirements, authorization status, and related administrative matters.
• Coordinate with providers, clinical staff, insurance representatives, and other healthcare personnel to facilitate timely patient care.
• Assist with scheduling and other administrative tasks related to authorized services when needed.
• Maintain accurate patient and insurance information in the practice's systems.
• Handle protected health information and other sensitive patient information with strict confidentiality.
• Ensure authorization-related tasks are completed accurately and within required timeframes.

Requirements:

• Previous experience in a healthcare administrative, medical office, or medical billing environment.
• Hands-on experience processing HMO authorizations and prior authorizations is required, including submitting, tracking, and following up on authorization requests.
• Experience communicating with insurance companies or health plans and working with insurance portals or online authorization systems.
• Strong understanding of insurance verification, authorization requirements, and healthcare administrative workflows.
• Strong attention to detail and accuracy when handling patient and insurance information.
• Excellent written and verbal English communication skills, with professional communication skills when interacting with patients, providers, and insurance representatives.
• Strong organizational and follow-up skills, with the ability to manage multiple authorization requests and deadlines.
• Ability to work independently, prioritize time-sensitive tasks, and resolve administrative issues efficiently.
• Proficiency with Microsoft Office, email, and web-based healthcare systems.
• Familiarity with HIPAA and the importance of protecting patient information.
• Familiarity with medical procedures, diagnostic testing, medications, and related authorization requirements is preferred.
• Experience handling authorization denials, resubmissions, and requests for additional clinical documentation is preferred.
• Experience with electronic medical records (EMR) or practice management systems is preferred.

Note: An NBI or police clearance will be required upon acceptance of the job offer.