Authorization & Eligibility Specialist

Conway Medical Center; Conway (SC); On-site; USD 25,000 - 36,000; Full time

Job summary

Conway Medical Center is seeking an Authorization Specialist to determine if authorizations are required for orders and to verify patient insurance details for accurate reimbursement.

You will review demographics, manage insurance information, educate patients on coverage, and work with frontline staff to secure timely payments.

The role requires 2 years in hospital/physician billing or pre-authorization, familiarity with EHR systems, and knowledge of Medicare/Medicaid, HMOs, and PPOs.

Qualifications

• Requires High School Diploma; preferred healthcare certification(s).
• 2 years hospital/physician billing, pre-authorization, or insurance verification experience.
• Knowledge of Medicare/Medicaid, HMO/PPO networks required.
• Familiarity with EHR systems and insurance eligibility tools.

Responsibilities

• Collaborates with designated clinical contacts for escalation to peer-to-peer review.
• Facilitates submission of clean claims and reduces payer denials by following policies.
• Educates and counsels patients on insurance coverage and payment options.
• Works with front-line staff to secure collections at time of presentation.
• Demonstrates exemplary customer service and clear written and verbal communication.
• Proficient with PC/technology and able to thrive in a fast-paced environment.
• Performs other duties as assigned by department leadership.

Skills

Communication skills

Customer service

Attention to detail

Healthcare insurance knowledge

Education

High School Diploma

Associate degree in ICD-10-CM/ICD-10-PCS

Certified Health Access Associate credential

CPT, HCPCS certification preferred

Job description

Conway Medical Center is seeking an Authorization Specialist to determine if authorizations are required for orders and to verify patient insurance details for accurate reimbursement.

You will review demographics, manage insurance information, educate patients on coverage, and work with frontline staff to secure timely payments.

The role requires 2 years in hospital/physician billing or pre-authorization, familiarity with EHR systems, and knowledge of Medicare/Medicaid, HMOs, and PPOs.