Authorization Specialist

violet health | Infusion Care•Sylvan Lake, MI

About The Position

We are seeking a proactive, highly organized Patient Intake & Prior Authorization Specialist to manage front-end patient onboarding and coverage approvals. This dual-focus role verifies patient eligibility, registers incoming referrals, secures insurance prior authorizations, and coordinates directly with clinical teams and third-party payers.

Requirements

At least 2 years of experience in healthcare intake, patient access, prior authorization, or medical billing/scheduling.
In-depth understanding of prior authorization workflows, payer portals, and medical terminology, including ICD-10, CPT, and HCPCS codes.
Hands-on experience with EHR or Practice Management platforms such as Epic, Athenahealth, Cerner, or Kareo.
Excellent communication and phone etiquette, strong attention to detail, and ability to multitask in a fast-paced environment.
High school diploma or equivalent required.

Nice To Haves

Associate degree or relevant medical administrative certification preferred.

Responsibilities

Accurately collect and enter demographic, clinical, and insurance information for new and returning patients into the Electronic Health Record (EHR) system.
Verify active coverage, copayments, coinsurance, deductibles, and network status across commercial plans, Medicare, and Medicaid.
Prepare, submit, and track prior authorization requests for specialist consultations, procedures, diagnostic tests, and pharmaceuticals according to payer-specific criteria.
Collaborate with physicians, nurses, and medical assistants to obtain necessary clinical documentation, chart notes, and letters of medical necessity.
Monitor pending authorization requests, identify root causes for initial coverage denials, assist in drafting appeals, and schedule peer-to-peer clinical reviews when needed.
Keep patients informed about authorization status, explain coverage limitations or out-of-pocket responsibilities clearly, and provide compassionate customer service.
Adhere to HIPAA guidelines, payer compliance timelines, and organizational protocols for document handling.