Insurance Authorization Specialist

Job Description

Job Title: Pre-Authorizations Specialist

Type: Contract

Pay: $19-26 per hour

Location: On-site, Louisville, KY

Software: Epic

Job Summary:

The Pre-Authorizations Specialist is tasked with liaising between third-party payers and healthcare providers to ensure timely and accurate pre-authorizations for physician services. This role involves verifying payment for tests and procedures before their administration and conducting insurance and benefit verification as part of the pre-authorization process.

Job Responsibilities:

Review, evaluate, and process pre-certification requests for various clinic procedures conducted by providers.

Initiate contact with insurance companies for pre-certification at least seven days before the scheduled procedure.

Utilize basic coding knowledge and medical terminology proficiency to translate orders into appropriate CPT and Diagnosis information for third-party payers.

Collaborate with providers to arrange peer-to-peer reviews with payers or explore alternative options for tests or procedures that don't meet pre-authorization criteria.

Gather all necessary information from third-party payers to complete prior authorizations, including reviewing medical documents for relevant clinical history.

Enter all prior authorization details into the scheduling and billing system accurately.

Aid clinics in obtaining prior authorizations for emergency admissions and same-day visits or procedures.

Ensure compliance with institutional, state, and federal practices by confirming all necessary billing information and eligibility requirements.

Verify patient eligibility and prior authorization needs through online verification software or telephone and follow up with payers promptly.

Maintain clear communication channels with clinic personnel and assist in training new team members.

Provide team coverage and undertake additional tasks as assigned by the supervisor.

Minimum Education & Experience:

High school diploma or GED required; college preparation preferred.

At least 1 year of experience in a healthcare prior authorization or insurance authorization role. Experience with surgical or imaging authorizations preferred.

Basic understanding of coding, familiarity with CPT and ICD-10, and proficiency in medical terminology.

Pay Details: $19.00 to $26.00 per hour

Search managed by: Joseph Ardaiolo

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.