Hospital Authorization Specialist

About This Role

The Hospital Authorization Specialist ensures the seamless authorization of hospital procedures for patients by coordinating with providers, insurance companies, and hospital staff. This role is vital for securing necessary pre-authorizations, addressing denials, and maintaining accurate records to facilitate timely patient care.

Responsibilities

• Review and manage daily hospital procedure schedules to identify pre-authorization needs
• Obtain authorizations from insurance companies using phone, fax, and online portals
• Verify that CPT and ICD-10 codes align with scheduled procedures and insurance requirements
• Collaborate with providers to handle peer-to-peer requests and appeal denied authorizations
• Communicate with patients about procedure approvals, reschedules, or cancellations
• Read medical charts to ensure procedures align with providers' plans
• Work closely with hospital pre-service teams to confirm all authorizations are accurate and complete
• Maintain up-to-date knowledge of insurance guidelines and ensure compliance with all HIPAA regulations

Requirements

• High School Diploma or GED
• 1-3 years of experience in medical authorization, healthcare administration, or a related field
• Strong understanding of medical terminology and insurance guidelines
• Excellent attention to detail and organizational skills

Qualifications

• High School Diploma or GED
• 1-3 years of experience in medical authorization, healthcare administration, or a related field

Nice to Have

• Familiarity with ICD-10 and CPT coding
• Prior experience with pre-authorizations or appeals processes
• Experience using healthcare systems like EPIC or other EMR platforms

Skills

* Required skills

Benefits