Authorization Specialist / Head - U.S. Medical Billing

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.

Requirements

• Experience working with insurance payers and prior authorization processes.
• Knowledge of ICD-10 and CPT coding.
• Valid U.S. visa.

Benefits

Additional Information

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.

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Company Intel

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