Job Overview

Our client is looking for a Medical Insurance Verification & Authorization Specialist who will be responsible for verifying patient insurance benefits, obtaining prior authorizations, and ensuring all required documentation is secured before services are rendered. This position works closely with physician offices, insurance companies, patients, and facility staff to minimize claim denials and ensure timely reimbursement.

Schedule

• Monday - Friday, 8:00 AM - 5:00 PM PST, with 1 hour unpaid/paid break (40 hours per week)

Responsibilities

• Insurance Eligibility Verification: Verify patient insurance coverage, benefits, and eligibility prior to scheduled services or procedures. Confirm effective dates, policy status, deductibles, copayments, coinsurance, and out-of-pocket responsibilities. Review payer-specific requirements and benefit limitations. Document verification details accurately in the practice management or electronic health record system.
• Prior Authorization Management: Obtain prior authorizations for surgeries, procedures, diagnostic testing, and specialty services. Submit authorization requests with all required clinical documentation. Follow up with insurance carriers regarding pending authorization requests. Track authorization status and expiration dates. Maintain accurate records of authorization numbers and approvals.
• Coordination and Communication: Communicate with physician offices, surgery schedulers, facility staff, and patients regarding authorization requirements and insurance coverage. Notify appropriate staff of authorization approvals, denials, or additional information requests. Assist patients with understanding insurance benefits and financial responsibilities. Escalate complex authorization or eligibility issues to management when necessary.
• Documentation and Compliance: Ensure all eligibility and authorization documentation complies with payer and regulatory requirements. Maintain organized records of all communications, approvals, denials, and supporting documentation. Monitor payer policy changes and authorization requirements. Protect patient confidentiality and comply with HIPAA regulations.
• Denial Prevention and Follow-Up: Identify potential insurance issues before services are rendered. Work proactively to prevent authorization-related claim denials. Assist with appeals and resubmissions when authorizations are denied. Research payer guidelines to support authorization requests.

Requirements

• Education: High school diploma or equivalent required.
• Experience: Minimum 2 years of medical insurance verification and authorization experience.
• Industry Knowledge: Knowledge of commercial, Medicare, Medicaid, HMO, PPO, and Workers' Compensation plans. Familiarity with CPT, ICD-10, and HCPCS coding.
• Technical Skills: Experience with electronic medical records (EMR/EHR) and practice management systems.
• Core Competencies: Strong organizational and time management skills. Excellent verbal and written communication skills. Ability to manage multiple priorities in a fast-paced healthcare environment.

Qualifications

• Ambulatory Surgery Center (ASC) experience (Preferred)
• Surgical scheduling experience (Preferred)
• Multi-specialty authorization experience (Preferred)
• Appeals and denial management experience (Preferred)

Performance Expectations

• Complete eligibility verification prior to scheduled services.
• Obtain authorizations within payer-required timeframes.
• Maintain accurate documentation and tracking logs.
• Reduce authorization-related denials and delays.
• Demonstrate professionalism and excellent customer service when interacting with patients, providers, and payers.

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations

Note

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.