Job Description

The Authorization Specialist Sr is responsible for coordinating and securing pre-certifications and pre-authorizations for procedures, diagnostic testing, and medications to ensure timely patient access to care. This role facilitates communication between referring providers, insurance carriers, and clinical departments to streamline scheduling and maintain continuity of care. The specialist triages and transcribes patient calls, schedules outpatient appointments, enters detailed documentation in the EMR, and provides guidance to patients throughout the authorization process. As a senior-level role, this position supports other authorization specialists and serves as the primary liaison to internal departments to resolve complex authorization issues and ensure efficient workflow operations.

Required:

High School Diploma or GED

Work Experience and Additional Information

Five (5) years of relevant medical office experience to include auth/pre-cert. Knowledge of medical terminology, CPT & ICD-9 coding. Excellent communication skills

Technical Knowledge, Skills and Abilities

• Comprehensive knowledge of insurance authorization processes including pre-certification requirements, medical necessity guidelines, and payer-specific policies.
• Strong proficiency in EMR systems (e.g., EPIC) with the ability to document detailed notes, track authorization statuses, and manage patient scheduling.
• Excellent communication and interpersonal skills to work effectively with physicians, insurance carriers, patients, and internal departments.
• Ability to analyze and interpret clinical information to determine authorization needs and compile documentation for peer-to-peer reviews.
• Strong organizational and time-management skills to manage multiple authorizations, meet deadlines, and ensure timely scheduling.
• Customer service and patient education skills to guide patients through the authorization and scheduling process with clarity and compassion.

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