Insurance Verification & Authorization Specialist

Better Health • Birmingham, AL

7d • 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 must follow up consistently 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 will maintain accurate documentation, manage work queues, communicate professionally, follow established workflows and payer-specific guidelines, and protect confidential patient information in accordance with HIPAA requirements.

Requirements

• Previous hands-on experience in the medical field.
• 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.
• Availability to work on-site in Birmingham, AL, for a minimum of 30 hours per week.

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 benefits, including deductibles, copayments, coinsurance, out-of-pocket expenses, network status, provider participation, coverage limitations, exclusions, and payer-specific requirements.
• Determine whether prior authorizations or PCP referrals are required and document verification results in appropriate systems.
• Communicate insurance findings and potential patient financial responsibilities to internal teams.
• Review insurance policies for authorization requirements for medical services, supplies, and durable medical equipment (DME).
• Submit authorization requests with required documentation and follow up with insurers 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 as needed.
• Maintain records of authorization submissions, follow-ups, and payer responses, and communicate updates to internal departments.
• Verify whether insurance plans require PCP referrals, contact PCP offices to obtain them, and submit referral requests and supporting documentation.
• Follow up with provider offices and insurers on outstanding referrals and track submission dates, status, and effective and expiration dates when applicable.
• Resolve referral issues, including missing information, incorrect provider details, and processing delays, 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 by 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.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed