Central Authorization Specialist

Description:

The Central Authorization Specialist is responsible for facilitating and validating insurance authorizations for medical procedures and post-operative care across multiple practice sites. The role ensures the accuracy and timeliness of authorizations, promotes workflow efficiency, and supports the overall revenue cycle process through education, feedback, and collaboration.

Key Responsibilities:

• Obtain and validate insurance authorizations for ordered procedures and post-operative care.

• Act as a central resource for assigned specialties to ensure standardized authorization practices.

• Provide education and feedback to clinical and administrative staff on improving authorization workflows.

• Collaborate with coding, billing, and denial management teams to identify and address authorization issues.

• Apply process improvement methodologies to enhance accuracy and efficiency.

• Support physicians and nurses by interpreting clinical notes to facilitate required authorizations.

• Maintain compliance with organizational policies and payer regulations.

Education & Experience Requirements:

• High school diploma or equivalent required; additional coursework in business, computers, or healthcare administration preferred.

• 3–5 years of experience in a medical clinic or healthcare setting.

• 2+ years of experience in healthcare insurance verification and/or billing.

• Knowledge of coding, clinical terminology, and patient treatment plans.

• Familiarity with revenue cycle processes, including billing, coding, charge capture, and reimbursement.

• Strong organizational, analytical, and communication skills.

• Ability to work independently and interact effectively with clinicians, payors, and finance staff.