Job Description – Authorization Specialist / Head – U.S. Medical Billing
Position: Intake Specialist/Head
Department: Medical Billing / Revenue Cycle Management
Location: Work from Office
Reports To: RCM Manager
Job Summary:
The Authorization Specialist / Head – U.S. Medical Billing is responsible for managing patient referrals, verifying insurance eligibility, obtaining prior authorizations/LOA, and ensuring all necessary documentation is collected for seamless billing and claims processing. This role requires excellent communication skills, attention to detail, and a deep understanding of medical billing procedures.
Key Responsibilities:
Referral & Intake Processing:
- Receive and review patient referrals from providers or healthcare facilities.
- Verify patient demographics and insurance details in the system.
- Ensure all required documentation (insurance cards, physician orders, prescriptions, etc.) is obtained.
Insurance Verification & Authorization:
- Verify patient eligibility and benefits with primary and secondary insurance.
- Obtain prior authorizations/LOA and approvals as required by the insurance provider.
- Track authorization status and follow up on pending requests.
- Communicate authorization approvals or denials to the relevant teams.
Data Entry & Documentation:
- Accurately enter patient and insurance information into the billing system.
- Maintain up-to-date records of all referrals, authorizations, and eligibility checks.
- Ensure compliance with HIPAA and company policies regarding patient data security.
Coordination & Communication:
- Act as a liaison between the billing team, providers, and insurance companies.
- Communicate with patients regarding insurance coverage, co-pays, and out-of-pocket costs when necessary.
- Collaborate with the RCM team to resolve issues related to eligibility, benefits, and authorizations.
Requirements & Qualifications:
- Education: Bachelor's or Master's degree.
- Experience: Minimum of 10 years of experience in medical billing, intake, insurance verification, and authorizations.
- Skills:
- Strong knowledge of medical billing processes, insurance verification, and authorizations.
- Familiarity with healthcare payers, including Medicare, Medicaid, and commercial insurance.
- Proficiency in medical billing software and electronic health record (EHR) systems.
- Excellent communication and customer service skills.
- Attention to detail and ability to multitask in a fast-paced environment.
Preferred Qualifications:
- Experience working with insurance payers and prior authorization processes.
- Knowledge of ICD-10 and CPT coding.
- Valid U.S. visa.
All Care Therapies is an equal opportunity employer. All aspects of employment, including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.
