FT - Patient Access and Authorization Specialist
On-siteMuenster, Texas, United States
Job Summary
Coordinate insurance prior authorizations and referrals for therapy, radiology, and outpatient services by reviewing physician orders, clinical documentation, and medical necessity requirements before submitting requests through various payer channels. Track pending authorizations, follow up with insurance companies, and communicate approvals, denials, and expiration dates to clinical staff while verifying valid physician referrals before services are provided. Provide administrative support for utilization review activities, gather clinical documentation, and track inpatient and observation requests as assigned. Serve as a backup receptionist during breaks, lunches, and increased patient volume to greet visitors, answer calls, and assist with patient registration and insurance verification. Maintain accurate records in the electronic health record and follow hospital policies, compliance requirements, and HIPAA standards.
Required Qualifications
- High school diploma or equivalent
- Must be able to sit or stand for extended periods
- Must be able to occasionally lift or move office materials weighing up to 20 pounds
- Regular use of a computer, telephone, fax machine, scanner, and other office equipment is required
- Frequent interaction with patients, visitors, staff, providers, and insurance representatives is required
- Must be available during normal business office hours
- Must provide reception coverage as assigned
- Dependable attendance
- Flexibility to provide reception coverage when needed
- Ability to maintain patient confidentiality and comply with HIPAA requirements
- Ability to understand and follow payer guidelines and hospital procedures
- Ability to work independently while recognizing when an issue should be escalated
- Attention to detail and ability to accurately document authorization information
- Ability to manage multiple requests, deadlines, and payer requirements
- Strong written and verbal communication skills
- Professional and courteous customer service skills
- Ability to communicate effectively with patients, physician offices, insurance companies, and hospital staff
- Strong organizational and time-management skills
Desired Qualifications
- At least one year of experience in a medical office, hospital business office, patient access, insurance verification, referrals, billing, or prior authorizations
- Experience working with insurance companies and payer websites
- Basic knowledge of medical terminology, insurance plans, and healthcare documentation
- Experience with electronic health records and Microsoft Office applications
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