Lead Insurance Authorization Specialist

Omega•Boca Raton, FL

4d•$26•Remote

About The Position

Under limited supervision, the Lead Insurance Authorization Specialist coordinates the workload, and execution of the financial clearance process for scheduled and nonscheduled appointments. This role ensures services are financially cleared days in advance of care to optimize reimbursement and minimize financial risk. The Lead provides mentorship to the team while actively performing complex clearance duties, including verifying eligibility, securing authorizations, researching procedure codes, conducting financial work-ups, and managing pre-service collections.

Requirements

High School diploma or equivalent.
Minimum 2 years of experience in a hospital patient access/patient accounts department, medical office/clinic, or insurance company environment.
Proven experience interacting professionally with patients, alongside working knowledge of third-party payers, collections, and navigating electronic insurance verification/eligibility systems.
Strong baseline knowledge of medical and insurance terminology.
Adept at multi-tasking, setting deadlines, and prioritizing a variety of tasks independently, often shifting assignments on short notice in a fast-paced environment.
Strong analytical and critical thinking skills to resolve complex registration or insurance issues, utilize accurate judgement, and meet production metrics.
Excellent verbal, listening, and written communication skills to build trust, maintain credibility, and remain composed during stressful situations.
Perform data entry with accuracy while safeguarding corporate and client assets, proactively reporting any security compromises.
Skill in operating a computer and learning multiple software or hardware systems concurrently within an average workday.

Nice To Haves

Associate’s degree.
Knowledge of ICD-9 and ICD-10 coding conventions and CPT codes.
Familiarity with rules established by AHIMA, the American Medical Association (AMA), the American Hospital Association (AHA), and the Center for Medicare and Medicaid Services (CMS).

Responsibilities

Monitor, balance, and distribute daily tasks within the client and supervisor work queues to ensure team productivity targets are met.
Act as the first-line escalation point for team members facing complex payer authorization roadblocks or technical system issues.
Complete eligibility checks and verify coverage for inpatient and outpatient, scheduled and nonscheduled visits via phone or electronic payer systems.
Provide initial clinical documentation to carriers when requested.
Review, initiate, and secure pre-certifications and authorizations with physicians, PHO sites, or insurance companies.
Work with insurance companies to obtain retroactive authorizations for services already rendered and collaborate with providers, coders, and case management to appeal denied claims.
Contact patients, families, and physicians to collect, analyze, and record accurate demographic, clinical, and financial data.
Conduct financial work-ups, arrange phone collections/pre-service payments, and communicate pertinent data to financial counselors.
Adhere to all corporate policies, procedures, and regulatory standards, including EMTALA, HIPAA, and HIPAA HITECH.