Insurance Verification & Authorization Specialist

Aspire Allergy & Sinus•Austin, TX

10d•Onsite

About The Position

The Insurance Verification & Authorization Specialist works in the Revenue Cycle department at Aspire Allergy & Sinus, verifying patient insurance eligibility and benefits, obtaining prior authorizations and referrals when required, and confirming patients are cleared before services are provided. The role helps ensure services meet payer requirements and reduce authorization- and eligibility-related denials. Working with Scheduling, Front Desk, Clinical Operations, and Revenue Cycle, the specialist uses payer portals, practice management systems, and communication with insurance carriers to confirm coverage, secure authorizations, and estimate patient financial responsibility where appropriate. The position supports a positive patient experience and accurate reimbursement by confirming coverage and authorization requirements before visits. This is a fully onsite role at the Austin headquarters. The schedule is Monday through Thursday, 8 a.m. to 5 p.m., and Friday, 8 a.m. to 12 p.m., for a 40-hour work week.

Requirements

High school diploma or equivalent required.
At least 1 year of insurance verification or authorization experience in a healthcare setting.
Knowledge of commercial, Medicare, and Medicaid insurance guidelines.
Familiarity with payer portals and insurance carrier websites.
Strong attention to detail and organizational skills.
Excellent written and verbal communication skills.
Ability to prioritize and manage multiple workflows and deadlines.
Ability to work independently and collaborate with a team in a fast-paced environment.
Working knowledge of CPT and ICD-10 codes.
Experience working with payer portals for eligibility and authorization requests.

Nice To Haves

Healthcare, hospital, or medical office experience.
Familiarity with insurance verification, eligibility checks, or authorization workflows.
Experience with EHR or practice management systems such as NextGen, Athena, Epic, or similar.

Responsibilities

Verify patient insurance eligibility and benefits using payer portals and insurance carriers.
Confirm coverage details, including copays, deductibles, coinsurance, and service limitations.
Review patient demographic and insurance information and correct it in the practice management system as needed.
Complete insurance verification accurately and within required timelines before scheduled services.
Obtain prior authorizations and referrals required by payer guidelines for scheduled services, procedures, or testing.
Ensure authorization requests have required information, including CPT codes, diagnosis codes, and supporting documentation.
Track authorization requests and follow up with payers to secure approval before the date of service.
Confirm scheduled services have valid authorization when required by the payer and procedure.
Calculate estimated patient responsibility based on verified benefits and payer guidelines.
Communicate expected out-of-pocket costs to patients when appropriate before services.
Refer uninsured or underinsured patients to the Billing team for assistance or payment arrangements when needed.
Collaborate with Scheduling, Front Desk, and Clinical Operations to ensure patients are cleared for scheduled services.
Communicate authorization requirements, missing documentation, and insurance issues to appropriate staff.
Assist internal teams with insurance-related questions that may affect scheduling or patient care.
Document verification results, authorization details, and payer communications in the practice management system.
Maintain accurate records of verification and authorization activity.
Track authorization approvals and expiration dates.