Authorization Specialist

Med Center Health•Bowling Green, KY

About The Position

The Authorization Specialist obtains prior authorizations, precertifications, and other payer-required approvals for scheduled services and procedures. The role serves as a liaison among providers, clinical staff, scheduling teams, patients, and insurance payers to gather information, submit requests, follow up on pending approvals, and communicate authorization status. The specialist documents authorization activity accurately and communicates potential delays, denials, and other issues to appropriate stakeholders to support timely decisions and minimize delays in care. The position works with internal departments and external payer organizations to support financial clearance and compliance with payer requirements.

Requirements

Experience in healthcare, insurance verification, prior authorization, patient access, revenue cycle, or a related field is preferred.
High School Diploma or GED is preferred.
Knowledge of medical terminology, healthcare insurance plans, and payer authorization requirements is preferred.
Knowledge of prior authorization processes and reimbursement practices is preferred.
Strong verbal and written communication skills.
Strong organizational skills and attention to detail.
Ability to manage multiple priorities and meet established deadlines.
Ability to work effectively with patients, providers, clinical staff, and payer representatives.
Proficiency with computer systems and standard office software applications.
Experience with Epic or similar electronic health record systems is preferred.

Responsibilities

Review scheduled services and procedures to determine authorization, precertification, or other payer approval requirements.
Obtain prior authorizations, precertifications, and other payer-required approvals for scheduled services and procedures.
Verify payer requirements, coverage guidelines, clinical documentation needs, and submission processes.
Coordinate with insurance carriers, provider offices, clinical departments, scheduling teams, and patients to obtain information required for authorization requests.
Submit authorization requests with accurate patient, provider, service, diagnosis, procedure, and supporting clinical information.
Monitor authorization work queues and follow up on pending requests to support timely financial clearance.
Track authorization status, payer determinations, approval numbers, effective dates, and related information in designated systems.
Communicate approvals, delays, denials, missing information, and other issues to appropriate stakeholders in a timely manner.
Escalate complex authorization issues, payer delays, urgent requests, or potential barriers to the appropriate supervisor or department contact.
Assist with authorization-related denials, payer inquiries, and requests for additional information.
Maintain current knowledge of payer authorization requirements, medical necessity guidelines, coverage policies, and workflow changes.
Ensure authorization processes comply with payer requirements, regulatory standards, and organizational policies.
Support denial prevention through accurate authorizations, timely follow-up, and complete documentation.
Participate in process improvement activities to enhance authorization efficiency, accuracy, and service quality.