Insurance Verification & Authorization Specialist

Better Health

1d•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 involves verifying insurance benefits, checking authorization requirements, obtaining prior authorizations, and submitting and following up on Primary Care Provider (PCP) referrals. The specialist follows up with insurance companies, provider offices, and internal teams to ensure requirements are met before services or equipment are provided. The position requires on-site work in Birmingham, Alabama, for a minimum of 30 hours per week. The specialist maintains accurate documentation, manages work queues, communicates with insurance representatives and medical offices, follows workflows and payer guidelines, identifies recurring issues for management, and protects confidential patient information in accordance with HIPAA requirements.

Requirements

Previous hands-on experience in the medical field.
Availability 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, active coverage, benefits, provider participation, coverage limitations, exclusions, and payer-specific requirements.
Determine whether prior authorizations or PCP referrals are required and document verification results.
Communicate insurance findings and potential patient financial responsibilities to appropriate internal teams.
Submit prior authorization requests with required documentation and follow up with insurance companies and utilization management departments.
Track authorization status, approval and expiration dates, and approved service periods; identify missing information and escalate delayed, denied, or urgent requests.
Maintain accurate records of authorization submissions, follow-ups, payer responses, and communicate updates to internal departments.
Verify whether insurance plans require PCP referrals; contact PCP offices, request and submit referrals with supporting documentation, and follow up on outstanding referrals.
Track referral submission dates, approval status, effective dates, and expiration dates when applicable; resolve referral issues and ensure referrals are documented before applicable services or orders proceed.
Maintain accurate and timely documentation in electronic systems and manage assigned work queues, prioritizing requests based on urgency and aging.
Communicate professionally with insurance representatives, medical offices, and internal teams, and 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.