Insurance Verification & Authorization Specialist

Better Health•Birmingham, AL

9d•Onsite

About The Position

We are seeking an experienced Insurance Verification & Authorization Specialist with a strong background in the medical field to support revenue cycle and patient intake operations. The role verifies insurance benefits, checks authorization requirements, obtains prior authorizations, and submits and follows up on Primary Care Provider (PCP) referrals. It requires attention to detail, strong communication, and consistent follow-up with insurance companies, provider offices, and internal teams to ensure requirements are met before services or equipment are provided. Previous experience in medical insurance verification, prior authorizations, and PCP referral coordination is required. The specialist verifies eligibility and coverage, reviews benefits and payer-specific requirements, submits and tracks authorization and referral requests, maintains accurate documentation, manages work queues, communicates updates, and protects confidential patient information in accordance with HIPAA requirements. The role must be performed on-site in Birmingham, Alabama, for a minimum of 30 hours per week.

Requirements

Previous hands-on experience in the medical field.
Must be available to work on-site in Birmingham, Alabama, for a minimum of 30 hours per week.
Experience with medical insurance eligibility and benefits verification.
Experience checking and obtaining prior authorizations.
Experience submitting PCP referrals and following up with provider offices.
Knowledge of commercial insurance and government healthcare plans, such as Medicare and Medicaid.
Understanding of in-network benefits, deductibles, coinsurance, referral requirements, and authorization processes.
Strong organizational skills and attention to detail.
Excellent written and verbal communication skills.
Ability to manage multiple requests and follow up on outstanding items without constant supervision.
Proficiency with computers, spreadsheets, and electronic documentation systems.
Ability to handle confidential patient information in accordance with HIPAA requirements.

Nice To Haves

Experience working with durable medical equipment (DME), medical supplies, or healthcare revenue cycle operations.
Experience with insurance portals and eligibility verification tools.
Familiarity with electronic health records (EHRs), practice management systems, and ticketing or CRM platforms.
Experience working directly with insurance companies, medical offices, and provider referral departments.

Responsibilities

Verify patients' insurance eligibility and active coverage.
Review insurance benefits, including deductibles, copayments, coinsurance, and out-of-pocket expenses.
Confirm in-network and out-of-network benefits and provider participation.
Identify coverage limitations, exclusions, and payer-specific requirements.
Determine whether prior authorizations or PCP referrals are required.
Document verification results accurately in appropriate systems.
Communicate insurance findings and potential patient financial responsibilities to internal teams.
Review insurance policies to determine prior authorization requirements for medical services, supplies, or durable medical equipment.
Submit authorization requests with required documentation.
Follow up with insurance companies and utilization management departments about pending authorizations.
Track authorization status, approval and expiration dates, and approved service periods.
Identify missing documentation or additional information needed for authorization requests.
Escalate delayed, denied, or urgent authorization requests as needed.
Maintain records of authorization submissions, follow-ups, and payer responses.
Communicate authorization updates and requirements to internal departments.
Verify whether insurance plans require a PCP referral.
Contact PCP offices to request and obtain required referrals.
Submit referral requests and supporting documentation according to payer requirements.
Follow up with provider offices and insurance companies on outstanding referrals.
Track referral submission dates, approval status, effective dates, and expiration dates when applicable.
Resolve referral issues, including missing information, incorrect provider details, and processing delays.
Ensure referrals are documented and available before applicable services or orders proceed.
Maintain accurate and timely documentation in electronic systems.
Manage assigned work queues and prioritize pending requests based on urgency and aging.
Communicate professionally with insurance representatives, medical offices, and internal teams.
Follow established workflows and payer-specific guidelines.
Identify recurring insurance, authorization, and referral issues and report them to management.
Protect confidential patient information and comply with HIPAA requirements.