Authorization Specialist II #Full Time #Remote
$51,501–$68,994 year
Hybrid · New York, United States or New Jersey, United States
Job Summary
Authorization Specialist II, primarily remote with occasional training/meetings in NY/NJ offices. Responsible for verifying insurance benefits, securing payer-required authorizations, and providing pre-authorizations for professional services prior to patient visits or hospital admissions. Tasks include verifying coverage via payer portals, confirming provider participation with plans, determining referral and authorization requirements, contacting patients/PCPs for referrals, documenting referrals in the practice management system, obtaining missing demographic/insurance information, reviewing clinical documentation for insurance criteria, initiating authorizations, following through to final approval, and handling appeals for denials. Also involved in patient out-of-pocket estimates, supporting special projects, and serving as back-up to senior specialists. Requires strong customer service, communication, and technical skills with familiarity in Epic or similar systems; remote work in the Tri-State area with periodic office visits.
Required Qualifications
- High school graduate or GED certificate is required
- A minimum of 1-year experience in a physician�s billing or third payer environment
- Ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations
- Strong customer service and patient-focused orientation
- Effective communication skills both verbally and written
- Multi-tasking and time-management abilities
- Familiarity with medical terminology
- Proficiency with Microsoft Word, Excel and Outlook; E-mail
- Experience with Epic or other electronic billing systems preferred
- Knowledge of medical terminology, diagnosis and procedure coding preferred
- Experience in an academic healthcare setting preferred
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