Insurance Authorization Specialist

Benefits: Health insurance Dental insurance Vision insurance Life Insurance Pet Insurance Health savings account Paid sick time Paid time off Paid holidays Profit sharing Retirement plan

General Summary: The Insurance Authorization Specialist is responsible for securing insurance authorizations for medical services to ensure timely patient care and accurate reimbursement. This role works under the guidance of the Manager/Supervisor and Team Lead of Financial Clearance, contributing to the team's overall goals in prior authorization accuracy, turnaround time, and financial risk mitigation.

Requirements: Essential Job Function/Competencies The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to: Initiate and track insurance prior authorizations for scheduled procedures, imaging, and other medical services. Verify insurance eligibility and benefits using payer portals or through direct contact with payers. Accurately document authorization statuses in the electronic medical record (EMR) and Practice Management (PM) system. Ensure all authorizations are obtained prior to the scheduled date of service to avoid delays or denials. Work closely with the Manager/Supervisor and Team Lead of Financial Clearance to escalate urgent or complex authorization cases. Support team objectives and contribute to departmental huddles and workflow optimization initiatives. Participate in ongoing training and feedback sessions led by the Supervisor to enhance performance and process compliance. Communicate with insurance carriers to gather necessary clinical documentation and follow up on pending requests. Identify and report recurring payer issues or trends to the Supervisor for team-level resolution or escalation. Inform patients of authorization status, potential delays, and what to expect if coverage issues arise. Coordinate with patient estimation staff to ensure authorizations align with cost estimates and pre-service collections efforts. Performs other position related duties as assigned. Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training. Certifications, Licenses or Registry Requirements N/A Knowledge | Skills | Abilities Comprehensive understanding of insurance verification, contract benefits and medical terminology. Ability to follow policies and procedures and enter data into various electronic systems while maintaining the integrity and accuracy of the data. Professional verbal and written communication skills. Proficient in payer portals, EMR systems, and Microsoft Office. Excellent organizational skills and attention to detail. Excellent customer service skills. Strong analytical and problem-solving skills. Able to work effectively under supervision and in a collaborative, team-oriented environment. Detail-oriented, organized, and able to manage multiple authorizations simultaneously.

Education Requirements: High School Diploma or equivalent required. Associate's degree in healthcare administration, billing, or related field preferred.

Experience Requirements: Minimum 1 year of experience in medical office, insurance verification, or healthcare billing. Familiarity with payer rules, authorization requirements, and EMR documentation preferred. Required Travel N/A

Physical Demands: Carrying Weight Frequency 1-25 lbs. Frequent from 34% to 66% 26-50 lbs. Occasionally from 2% to 33% Pushing/Pulling Frequency 1-25 lbs. Seldom, up to 2% 100 + lbs. Seldom, up to 2% Lifting - Height, Weight Frequency Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33% Floor to Chest, 26-50 lbs. Seldom: up to 2% Floor to Waist, 1-25 lbs. Occasional: from 2% to 33% Floor to Waist, 26-50 lbs. Seldom: up to 2%