Authorization Specialist

Lehigh Valley Health Network

. Obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services .

Posted 9/15/2026full-timeRemote • Pennsylvania • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in insurance verification, authorization processes, and billing procedures within a healthcare setting. Proficient in compliance with medical necessity standards and patient rights regulations, including HIPAA.

Highest-signal resume keywords

Insurance VerificationAuthorization ProtocolsBilling ProceduresUtilization ManagementMedical Necessity Checks

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance VerificationAuthorization ProtocolsBilling ProceduresUtilization ManagementMedical Necessity ChecksPayer ReimbursementPatient Rights KnowledgeCompliance StandardsHealthcare Certificate ProgramsStandard Medical Practices

Certifications & Qualifications

High School DiplomaGEDHealthcare Certificate Programs

Industry Keywords

HIPAAManaged CarePatient Financial ResponsibilityClinical InformationBenchmark Data

About the role

Key responsibilities & impact

Obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services
Determine authorization protocols for each health plan
Perform billing duties to ensure proper and timely payment from insurance carriers and patients
Collaborate with physicians and provider office staff to ascertain appropriate authorization based on medical necessity and treatment plans
Perform medical necessity checks to determine whether procedure and diagnosis support medical necessity
Ensure authorizations comply with network policy and communicate exceptions to the ordering office, patient, and manager
Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals
Verify additional clinical information and insurance authorizations/referrals
Review and monitor WQs/schedules to ensure proper and accurate authorization before patient visits
Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures
Determine estimated patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines

Requirements

What you’ll need

High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs
1 year in a healthcare setting with insurance verification/authorizations
Familiarity with billing procedures and payer reimbursement
Knowledge of patient rights and laws relative to those rights, such as HIPAA
Proficient in utilization management processes, standards, and managed care
Proficient in standard medical practices and insurance benefit structures
Ability to lift and carry 25 lbs.
Frequent sitting/standing and keyboard use

Benefits

Comp & perks

Full-time employment
Day shift schedule
Monday-Friday, 8:00a-4:30p work schedule