The
Medical Authorization Specialist is responsible for verifying insurance eligibility and benefits and ensuring all pre-certification, prior authorization, and referral requirements are completed accurately and timely for both facility and professional services. This role serves as a key liaison among patients, payors, providers, hospitals, and internal clinical teams to support uninterrupted patient care.
Key Responsibilities
- Monitor, review, and distribute department faxes and incoming authorization requests.
- Assist patients in understanding insurance requirements, benefits, and coverage related to their care.
- Answer incoming calls in a timely, accurate, and professional manner.
- Communicate with referring provider offices, hospital staff, and independent facilities to obtain accurate insurance, authorization, and referral information.
- Verify insurance eligibility and benefit levels to ensure appropriate coverage at the correct site of service.
- Obtain pre-certifications, prior authorizations, and referral approvals for required facility and professional services.
- Ensure all authorizations and referrals are secured prior to services being rendered.
- Submit clinical documentation to payors and communicate with clinicians to support medical necessity requirements.
- Coordinate peer-to-peer reviews when requested by insurance carriers.
- Maintain accurate and complete documentation within the practice management system.
- Assist with denial resolution related to authorization and pre-certification issues.
- Respond promptly to internal and external emails and inquiries.
Qualifications
- Minimum 3 years of experience as a Medical Authorization Specialist, Prior Authorization Specialist, Insurance Verification Specialist, or related healthcare authorization role.
- Strong knowledge of insurance authorization and referral processes.
- Familiarity with ICD-10 and CPT coding.
- Working knowledge of medical terminology.
- Excellent attention to detail and organizational skills.
- Ability to work independently, manage priorities, and meet deadlines.
- Strong verbal and written communication skills with a professional demeanor.
- Proficiency in using electronic medical records (EMR) and practice management systems.
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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Who are we
BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!
Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.
