Medical Receptionist

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Position Summary

The Insurance Authorization Specialist is responsible for obtaining prior authorizations, verifying insurance benefits, and ensuring all required documentation is completed before services are rendered. This position works closely with providers, clinical staff, patients, and insurance companies to facilitate timely approvals and minimize delays in patient care and reimbursement.

Essential Duties and ResponsibilitiesInsurance Verification & Authorizations

• Verify patient insurance eligibility and benefits.
• Obtain prior authorizations for procedures, surgeries, diagnostic testing, medications, and specialty services as required by insurance carriers.
• Submit authorization requests with supporting clinical documentation.
• Track pending authorizations and follow up with insurance companies to ensure timely determinations.
• Document authorization status, reference numbers, and approval details accurately in the electronic medical record (EMR).

Patient Communication

• Inform patients of authorization requirements, approval status, and any coverage limitations.
• Explain insurance-related requirements and financial responsibilities when applicable.
• Assist patients with obtaining necessary referrals from primary care providers.

Provider & Staff Collaboration

• Work closely with providers and clinical staff to obtain required medical records and supporting documentation.
• Communicate authorization denials, requests for additional information, and approval updates promptly.
• Coordinate scheduling to ensure services are authorized prior to appointments or procedures.

Denial Management

• Review authorization denials and identify reasons for denial.
• Assist with appeal submissions and reconsideration requests.
• Maintain detailed records of appeals and outcomes.

Compliance & Documentation

• Maintain confidentiality in accordance with HIPAA regulations.
• Ensure compliance with payer guidelines, Medicare, Medicaid, and commercial insurance requirements.
• Keep current with insurance carrier policies and authorization procedures.

QualificationsEducation

• High School Diploma or GED required.
• Medical administrative training or certification preferred.

Experience

• Minimum of 1-2 years of experience in insurance verification, prior authorizations, or medical office administration preferred.
• Experience with OB/GYN, specialty practice, or outpatient healthcare setting preferred.

Skills & Knowledge

• Knowledge of insurance plans, referrals, prior authorization processes, and medical terminology.
• Familiarity with EMR/EHR systems and practice management software.
• Strong organizational and time-management skills.
• Excellent communication and customer service abilities.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Proficient in Microsoft Office (Outlook, Word, Excel).

Physical Requirements

• Prolonged periods of sitting and computer use.
• Ability to communicate effectively by phone and in person.

Performance Expectations

• Timely completion of authorization requests.
• Accurate documentation of approvals and denials.
• Effective communication with patients, providers, and insurance carriers.
• Compliance with HIPAA and office policies.
• Maintenance of positive patient satisfaction and professional conduct.

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person