Insurance Authorization Specialist

Omega•Boca Raton, FL

4d•Remote

About The Position

Under limited supervision, the Insurance Authorization Specialist reviews and manages benefits, eligibility, and prior authorizations for hospitals and physicians, acting as a vital intermediary between the medical institution, patients, and insurance agencies. This role performs pre-registrations for scheduled accounts across multiple affiliates, coordinates financial estimations, and establishes patient payment arrangements. The Specialist acts as the primary documentation source for access and billing staff to optimize reimbursement and minimize financial risk.

Requirements

High school diploma, or equivalent.
Minimum 1-2 years of experience in medical billing, coding, hospital patient access, patient accounts, or a medical clinic environment.
Comprehensive understanding of hospital/physician billing and terminology (e.g., CPT, ICD-10, ICD-9, co-pays, deductibles, or co-insurance).
Previous customer service experience interacting professionally with a diverse environment.
Must be adept at multi-tasking and prioritizing a variety of tasks, often changing assignments on short notice in a fast-paced environment.
Strong analytical, critical thinking, and problem-solving skills to successfully manage individual KRAs and meet production metrics.
Excellent verbal, listening, and written communication skills to build trust, maintain credibility, and remain composed during stressful situations.
Perform data entry with accuracy while safeguarding corporate and client assets, proactively reporting any security compromises.
Skill in operating a computer and learning multiple software or hardware systems concurrently within an average workday.

Nice To Haves

Prior experience working directly with third-party payers, collections, and navigating insurance verification or eligibility systems.
Familiarity with coding conventions and rules established by AHIMA, the American Medical Association (AMA), the American Hospital Association (AHA), and the Center for Medicare and Medicaid Services (CMS).

Responsibilities

Maintain work queues and reports assigned by the supervisor and client.
Complete eligibility checks and verify benefits for inpatient and outpatient, scheduled and nonscheduled visits via phone or electronic payer systems.
Contact patients, families, and physicians to collect, analyze, and record accurate demographic, clinical, and insurance/financial data.
Update information in the system to ensure an appropriate information source for a clean verification and billing process.
Refer patients requiring structured payment plans to cash posting specialists.
Adhere to all corporate policies, procedures, and regulatory standards, including EMTALA, HIPAA, and HIPAA HITECH.