Authorization Specialist

Job Description

Job Description

Job Summary :

The Authorization Specialist will be responsible for obtaining prior authorizations for medical services, procedures, and tests for patients in the ENT (Ear, Nose, and Throat) practice. This role ensures timely submission of requests to insurance companies, follows up on pending authorizations, and maintains communication with patients and providers regarding insurance requirements. The Authorization Specialist will work closely with the clinical staff, billing team, and insurance carriers to ensure proper insurance coverage and timely approvals for treatment.

Key Responsibilities :

• Obtain Prior Authorizations :

Initiate and track the authorization process for ENT-related procedures, diagnostics, and treatments, such as surgeries, imaging, and outpatient services.

Verify patient insurance coverage for ENT services, identifying potential barriers to coverage or issues that may delay approval.

Maintain accurate and detailed records of authorizations, including all communications with insurance providers, and status updates for ongoing requests.

Track the status of authorization requests and follow up with insurance companies to ensure timely approvals.

Work closely with physicians and clinical staff to understand the specific needs of patients and assist with any special documentation or requirements for authorization.

Communicate with patients about the status of their authorization requests and any additional steps required to proceed with treatment.

High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred.

Previous experience in medical insurance authorization, billing, or coding (preferably in an ENT or healthcare setting) is highly preferred.

Strong organizational skills and attention to detail.

Certification in medical billing and coding (CPC, CBCS, etc.) is a plus.

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