Authorization Specialist

Desoto Memorial Hospital; Arcadia (FL); On-site; USD 36,000 - 56,000; Full time

Job summary

Desoto Memorial Hospital is seeking an Authorization Specialist to coordinate insurance pre-certifications and pre-authorizations for procedures, tests, and medications. You will serve as a liaison among providers, insurance carriers, patients, and external agencies, ensuring timely access to care and complete EMR documentation.

The role requires knowledge of CPT/ICD-10 coding and strong communication skills, with a fast-paced environment supporting care continuity and efficient authorization

Qualifications

• High School Diploma or GED or equivalent.
• License/Registration issued by Florida or Compact State.
• Six (6) months medical office experience, including auth/pre-cert.
• Knowledge of CPT & ICD-10 coding.
• Excellent communication skills.

Responsibilities

• Coordinate and secure insurance pre-certifications and pre-authorizations for medical procedures, outpatient testing, and prescribed medications.
• Serve as a liaison between providers, insurance carriers, patients, and external agencies to ensure timely access to care.
• Maintain complete and accurate documentation within the EMR to support continuity of care.
• Triaging patient communications and assisting with peer-to-peer reviews to resolve authorization barriers efficiently

Skills

Medical terminology

Communication skills

EMR documentation

Peer-to-peer review coordination

Education

High School Diploma or GED

License/Registration (Florida or Compact State)

Job description

General Summary

The Authorization Specialist is responsible for coordinating and securing insurance pre-certifications and pre-authorizations for medical procedures, outpatient testing, and prescribed medications. This role serves as a liaison between providers, insurance carriers, patients, and external agencies to ensure timely access to care while maintaining complete and accurate documentation within the electronic medical record (EMR). The Authorization Specialist supports continuity of care by facilitating appointments, triaging patient communications, and assisting with peer-to-peer reviews to resolve authorization barriers efficiently

Qualifications

• High School Diploma or GED And/or.
• License/Registration - Issued by Florida or Compact State And/or Certification.
• Six (6) months medical office experience to include auth/pre-cert.
• Knowledge of medical terminology, CPT & ICD-10 coding.
• Excellent communication skills.

Technical Knowledge, Skills, and Abilities

• Understanding of pre-certification, prior authorization, and referral requirements across various payer types, including commercial, Medicare, and Medicaid plans.
• Ability to accurately document clinical, insurance, and authorization details in an electronic medical record to ensure compliance and continuity of care.
• Strong written and verbal communication skills to interact effectively with physicians, insurance carriers, patients, and external healthcare organizations.
• Ability to educate and guide patients through complex authorization processes while delivering a positive, supportive patient experience.
• Ability to manage multiple authorizations, appointments, and deadlines simultaneously in a fast-paced clinical environment.
• Skill in gathering medical necessity documentation, identifying authorization barriers, and supporting peer-to-peer review coordination for timely resolution.