Authorization Specialist

Lehigh Valley Health Network • Pottstown, PA

1d • Onsite

About The Position

The Authorization Specialist obtains benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services as part of daily operations. The role determines authorization protocols for each health plan and performs billing duties to help ensure timely, appropriate payment from insurance carriers and patients.

The position works with physicians, provider office staff, insurers, and patients to confirm medical necessity, verify coverage, obtain approvals, monitor upcoming visits, and estimate patient financial responsibility. The role is onsite at 1601 Medical Drive in Pottstown, with a Monday–Friday, 8 a.m.–5 p.m. schedule on the day shift.

Requirements

• High school diploma or GED with specialized training in insurance, coding, billing, or a similar healthcare certificate program.
• One year of experience in a healthcare setting with insurance verification or authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and laws related to those rights, such as HIPAA.
• Proficiency in utilization management processes, standards, and managed care.
• Proficiency in standard medical practices and insurance benefit structures.

Nice To Haves

• Associate’s degree.

Responsibilities

• Collaborate with physicians and provider office staff to determine appropriate authorization based on medical necessity and the provided treatment plan.
• Check medical necessity to determine whether procedures and diagnoses support it.
• Obtain authorizations in accordance with network policy and communicate authorization issues outside policy guidelines to the ordering office, patient, and manager.
• Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals.
• Verify additional clinical information and insurance authorizations or referrals.
• Review and monitor work queues and schedules to ensure accurate authorization is received before the patient's visit.
• Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures.
• Determine estimated patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED