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Authorization Specialist III
61st Street Service Corp. Verify insurance coverage using system tools, payer portals, electronic query, real-time eligibility, and phone .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in verifying insurance coverage, managing authorizations, and navigating billing requirements within a healthcare environment. Proficient in communication and customer service, with a strong focus on patient needs and effective documentation.
Highest-signal resume keywords
Insurance VerificationAuthorization ManagementMedical TerminologyCustomer Service OrientationEpic Electronic Billing Systems
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance Billing RequirementsPre-Authorization ProcessesDiagnosis CodingProcedure CodingPatient Out-of-Pocket EstimatesQuality AuditsComplex Case ManagementDocumentation ManagementEligibility ResearchClinical Documentation Review
Soft Skills
Effective CommunicationAdaptabilityCalm Conflict ResolutionMulti-TaskingTime Management
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft OutlookEmail SystemsPayer PortalsBilling Systems
Certifications & Qualifications
Certified Professional Coder (CPC)
Industry Keywords
Managed Care EligibilityThird Party Payer EnvironmentAcademic Healthcare SettingTelework ComplianceTri-State Area Residency
About the role
Key responsibilities & impact- Verify insurance coverage using system tools, payer portals, electronic query, real-time eligibility, and phone
- Update billing-system information after verifying patient insurance coverage
- Confirm provider participation status with insurance plans and networks
- Determine payer authorization requirements for professional services
- Research system notes for missing or corrected insurance or demographic information
- Review clinical documentation to ensure procedures meet insurance criteria
- Initiate authorizations and submit requested clinical documentation to insurance companies
- Follow pre-certifications through final approval
- Manage faxes, emails, phone calls, voicemails, and email responses
- Communicate authorization statuses and denials to surgical coordinators
- Submit appeals for denied prior authorizations or payments
- Arrange peer-to-peer calls between clinical providers and insurance companies
- Calculate and document patient out-of-pocket estimates and provide them to patients
- Assist supervisors with special projects and tasks
- Support Authorization Specialists I and II with complex cases and eligibility issues
- Assist with daily work assignment distribution
- Assist with new-hire and refresher training materials
- Monitor and replenish office supplies
- Assist management with periodic quality audits
- Perform other assigned duties
Requirements
What you’ll need- High school graduate or GED certificate required
- Minimum of 2 years’ experience in a physician’s billing or third payer environment
- Ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations
- Strong customer service and patient-focused orientation
- Ability to communicate, adapt, and respond to complex situations
- Ability to diffuse complex situations in a calm and professional manner
- Effective verbal and written communication skills
- Ability to multi-task, prioritize, document, and manage time effectively
- Functional proficiency in Microsoft Word, Excel, Outlook, email, and similar computer software
- Functional proficiency and comprehension of medical terminology
- Must reside in the Tri-State area: New York, New Jersey, or Connecticut
- Must be in a Columbia University-approved telework state
- Certified Professional Coder (CPC) certificate preferred
- Experience in Epic or other electronic billing systems preferred
- Knowledge of medical terminology, diagnosis, and procedure coding preferred
- Previous experience in an academic healthcare setting preferred
Benefits
Comp & perks- Healthcare benefits
- Various other benefits
- Paid time off
- Primarily remote work arrangement
- Equal employment opportunity