Authorization Specialist (Remote in Wisconsin & Michigan)

Marshfield Clinic Health System • Minocqua, WI

1d • Remote

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 health care setting involving customer service or patient-facing responsibilities, or equivalent experience.
• Medical knowledge: Understanding of basic medical terminology, disease processes, and treatment options to accurately assess medical necessity.
• Insurance knowledge: Familiarity with different insurance plans, benefit structures, and prior authorization guidelines.
• Excellent communication skills: Ability to effectively communicate with healthcare providers, insurance companies, and patients to clarify information and address concerns.
• Attention to detail: High level of accuracy in data entry and review of medical records to ensure correct prior authorization requests.
• Problem-solving skills: Ability to identify potential issues with prior authorization requests, navigate complex situations, and find solutions to ensure timely patient care.

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

• 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
• Verifying patient eligibility
• Contacting insurance companies to obtain authorization
• Managing the process to minimize delays in patient care

Benefits

• Positions listed as 30 hours per week or greater are offered the level 1 benefit package.
• Positions listed as 20 – 29 hours per week are offered the level 2 benefit package.
• Positions listed as less than 19 hours per week are non-benefited.
• Benefits for temporary positions vary.
• Details will be discussed in the interview process.

What This Job Offers

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