Authorization Specialist (Remote in Wisconsin/Michigan)

Marshfield Clinic Health System • Marshfield, WI

91d

About The Position

The Authorization Specialist is a healthcare professional responsible for reviewing patient medical records to determine if a prescribed treatment, procedure, or medication requires prior authorization from the insurance company, ensuring that the requested care is deemed medically necessary and covered under the patient's benefits before it can be administered; this involves verifying patient eligibility, contacting insurance companies to obtain authorization, and managing the process to minimize delays in patient care. An Authorization Specialist works in a fast-paced environment with high call volumes, requiring strong organizational skills and the ability to manage multiple tasks simultaneously.

Requirements

• Two years’ experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities.
• Understanding of basic medical terminology, disease processes, and treatment options.
• Familiarity with different insurance plans, benefit structures, and prior authorization guidelines.
• Excellent communication skills.
• High level of accuracy in data entry and review of medical records.
• Problem-solving skills to navigate complex situations.

Nice To Haves

• Successful completion of post-secondary courses in Medical Terminology and Diagnosis and CPT Coding, and Anatomy & Physiology.
• Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program.

Responsibilities

• Review patient medical records to determine the need for prior authorization.
• Verify patient eligibility and contact insurance companies for authorization.
• Manage the authorization process to minimize delays in patient care.
• Communicate effectively with healthcare providers, insurance companies, and patients.
• Ensure accuracy in data entry and review of medical records.

Benefits

• Affordable living rich in leisure.
• Level 1 benefit package for positions listed as 30 hours per week or greater.
• Level 2 benefit package for positions listed as 20 – 29 hours per week.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees