Authorization Specialist

Role Over View:

The Authorization Specialist is responsible for handling the authorization process within the RCM workflow. This role ensures that all patient procedures and services are authorized by insurance providers and compliant with healthcare regulations, minimizing denials and improving reimbursement.

Key Responsibilities:

Authorization Requests: Submit and follow up on prior authorizations with insurance providers to obtain approvals for medical procedures, treatments, and services.

Insurance Verification: Verify patients insurance eligibility and coverage details to ensure accurate authorization.

Documentation Management: Maintain accurate records of all authorization requests, approvals, and denials, and update the system in real time.

Communication: Coordinate with healthcare providers, payers, and patients to resolve any authorization-related issues, delays, or inquiries.

Claims Support: Assist in reviewing and preparing documentation for claims submission, minimizing authorization-related denials.

Compliance: Adhere to HIPAA and other regulatory standards, ensuring patient confidentiality and secure handling of information