Authorization Specialist

Melissa Memorial Hospital•Holyoke, CO

1d•$18 - $27•Onsite

About The Position

The Authorization Specialist is responsible for obtaining prior authorizations and verifying insurance coverage for medical procedures, tests, and treatments. This role ensures that all services requiring pre-approval are appropriately documented and authorized before delivery, helping healthcare providers in the hospital and clinic areas secure payment and avoid claim denials. In addition to the responsibilities described above, the role may include other responsibilities and duties as assigned on occasion, based upon MMH needs or requirements.

Requirements

High School diploma or equivalent; Associate’s degree in healthcare administration or related field preferred.
1–3 years of experience in a healthcare setting, preferably in medical billing, insurance verification, or authorizations.
Knowledge of medical terminology, CPT/ICD-10 codes, and healthcare insurance processes.
Familiarity with EHR systems (e.g., Epic, Cerner, Athenahealth) and payer portals.
Excellent communication, organization, and customer service skills.
Strong attention to detail and ability to manage multiple priorities.

Nice To Haves

Certification in medical billing or coding (e.g., CPC, CCS, or CMRS).
Experience with government and commercial insurance payers (e.g., Medicare, Medicaid, BCBS, Aetna).
Bilingual (Spanish/English) preferred in some settings

Responsibilities

Insurance Verification: Verify patient insurance eligibility and benefits for specific procedures and services. Communicate with insurance companies to confirm coverage and requirements.
Prior Authorization: Submit prior authorization requests for medical services, diagnostic tests, surgeries, medications, and referrals. Monitor and follow up on pending authorizations to ensure timely processing.
Patient & Provider Communication: Notify patients and clinical staff of authorization status and any additional requirements. Serve as a liaison between the healthcare provider and insurance companies.
Documentation & Recordkeeping: Accurately document all authorization activities in the Electronic Health Record (EHR) system. Maintain up-to-date records of authorization approvals, denials, and appeals.
Compliance & Policy Adherence: Stay informed of changing insurance regulations, payer guidelines, and HIPAA requirements. Ensure compliance with all internal and external policies and procedures.