Authorization Specialist

• Monitor authorizations for upcoming surgical cases on physicians’ calendars
• Ensure surgery authorizations are obtained accurately and on time
• Verify patient demographic information and insurance eligibility, including coordination of benefits
• Update and confirm information needed for claims processing
• Complete surgical cost analysis forms and document required cost estimates for collection before services
• Verify benefits for all surgical procedures
• Document authorization status and progress in patient charts and case management
• Provide ongoing staff training and education regarding new processes
• Work with the department manager to respond to and reduce complaints
• Assist surgery schedulers with STAT authorizations
• Identify opportunities to improve daily workflow processes
• Attend department meetings as required
• Communicate with physicians, patients, coworkers, management, providers, and internal and external customers

Surgical Authorization Specialist

• Monitor authorizations of upcoming surgical cases on physicians’ calendars
• Ensure surgery authorizations are obtained accurately and on time
• Verify patient demographics, insurance eligibility, and coordination of benefits
• Update information needed for claims processing
• Complete surgical cost analysis forms and document cost estimates for collection before services
• Verify benefits for surgical procedures
• Document authorization progress in patient charts and case management
• Provide ongoing staff training and education on new processes
• Work with the department manager to address and reduce complaints
• Assist surgery schedulers with STAT authorizations
• Maintain confidentiality of health records and member information in accordance with HIPAA
• Identify workflow improvement opportunities
• Attend department meetings as required

• Act as a resource and support the prior authorization request process to ensure requests are addressed properly within contractual timelines
• Support the utilization management team with documentation and tracking of authorization requests and referrals
• Research and document medical information, including history, diagnosis and prognosis, for clinical reviewer determination
• Verify member insurance coverage and service/benefit eligibility using system tools
• Align authorizations with guidelines to support timely payment adjudication
• Perform data entry to maintain and update authorization requests in the utilization management system
• Process authorization requests according to the insurance prior authorization list and route them to appropriate clinical reviewers
• Remain up to date on healthcare authorization processes, policies and procedures
• Perform other duties as assigned
• Comply with all policies and standards

Authorization Specialist II

• Submit accurate and timely authorization requests to insurance companies and payers.
• Set up and maintain patient accounts in the system.
• Obtain and review clinical documentation to verify medical necessity.
• Communicate with healthcare providers to gather required authorization information.
• Verify insurance benefits and eligibility for services.
• Monitor authorization request status and follow up as needed.
• Ensure compliance with payer requirements and regulations.
• Apply basic medical coding, diagnosis codes, and medical terminology in the authorization process.
• Maintain detailed records and documentation for all authorizations.
• Collaborate with billing and claims teams to resolve authorization-related issues.
• May perform other duties as assigned.