Insurance Verification & Authorization Specialist

Texas Regional Physicians•Houston, TX

just now

About The Position

Texas Regional Physicians (TRP) is a physician-led, multi-specialty medical group committed to providing coordinated, patient-centered care across our clinical network. Our team works collaboratively to create a streamlined patient experience while supporting providers and clinical operations with accuracy, efficiency, and exceptional service. Position Summary Texas Regional Physicians is seeking a dependable and detail-oriented Insurance Verification & Authorization Specialist to join our team. This position is responsible for verifying patient insurance coverage and benefits, obtaining prior authorizations and referrals, processing GAP exceptions, and ensuring all required approvals are secured prior to scheduled services. The ideal candidate is highly organized, comfortable managing a high-volume and time-sensitive workload, and knowledgeable in insurance payer policies, authorization requirements, and online insurance portals.

Requirements

High School Diploma or GED required.
Minimum of 2 years of prior insurance verification or medical billing experience required.
Minimum of 2 years of experience in a medical or healthcare-related environment required.
Working knowledge of payer medical policies, guidelines, and authorization requirements.
Familiarity with commercial insurance portals and online payer systems.
Strong computer skills, including Microsoft Excel and Word.
Excellent verbal and written communication skills.
Strong customer service and interpersonal skills.
Exceptional attention to detail and organizational skills.
Ability to multitask, prioritize, and remain focused while managing a high-volume, time-sensitive workload.
Ability to work effectively both independently and as part of a team.
Dependable attendance and the ability to consistently work scheduled shifts.

Nice To Haves

Experience obtaining prior authorizations and referrals strongly preferred.

Responsibilities

Verify patient insurance coverage, eligibility, and benefits prior to scheduled appointments.
Verify coordination of benefits (COB) and resolve discrepancies as needed.
Submit and manage prior authorization requests for applicable medical services.
Obtain referrals and GAP exceptions as required by insurance carriers.
Track, prioritize, and follow up on pending authorizations to ensure timely completion.
Provide required clinical documentation to insurance carriers to support authorization requests.
Initiate appeals for upfront authorization denials and follow through until resolution.
Review payer medical policies and guidelines to determine authorization requirements.
Maintain consistent communication with clinical and scheduling teams regarding authorization status, approvals, denials, and outstanding requirements.
Contact patients when necessary to verify or obtain updated insurance information.
Accurately document insurance verification and authorization activity in applicable systems.
Navigate insurance carrier websites and payer portals to obtain eligibility, benefit, authorization, and referral information.
Provide professional and courteous customer service to patients and internal team members.
Assist patients with insurance-related questions regarding their account when appropriate.
Perform additional duties and special projects as assigned.