Authorization Specialist

L.O. Eye Care; Grand Ledge (MI); Hybrid; USD 45,000 - 65,000; Full time

Job summary

L.O. Eye Care is seeking an Authorization Specialist to manage insurance verifications, obtain pre-approvals, and ensure timely authorization for procedures and medications.

The role emphasizes accurate documentation and communication with hospitals, providers, patients, and insurers. The ideal candidate will have 3–5 years in healthcare billing, familiarity with CPT/ICD coding, and a strong commitment to patient confidentiality and accuracy.

Qualifications

• Clear communication skills, both written and verbal.
• Experience with medical billing processes and HIPAA rules.
• Familiarity with vision insurance and medical payers.

Responsibilities

• Contact insurance carriers to verify patient eligibility and benefits.
• Request and obtain pre-authorization from insurers within required timeframes.
• Obtain prior-authorizations before services are performed.
• Document communications with providers in standardized formats.
• Attend meetings and training; assist with policy compliance.

Skills

Communication

Conscientious

Teamwork

Adaptability

Trustworthy

Patient confidentiality

Education

High School Diploma or GED

3–5 years healthcare billing experience

HIPAA knowledge

Tools

NextGen

Job description

SummaryThe Authorization Specialist, a key position in the Revenue Cycle, obtain authorizations/reauthorizes all procedures, surgeries, and medications/injectable. This position requires excellent follow-up and correspondence with external sources such as hospital/surgery centers, providers, patients, and insurance inquiries/correspondence.Supervisory responsibilitiesThis role has no supervisory responsibilities.Essential functionsThe following list is a summary of the key functions of the job and may not be inclusive of all duties assigned.Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.Request, track and obtain pre-authorization from insurance carriers within time allotted for services.Request, follow up and secure prior-authorizations prior to services being performed.Communicate any insurance changes or trends among team.Maintains a level of productivity suitable for the department.Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.Attend and participate in meetings and trainingComplying with rules, regulations, policies, and procedures for collecting payments.Performing other duties as assigned.Core CompetenciesAll employees of L.O. Eye Care are expected to demonstrate the following core competencies, regardless of position or status. Additional job-specific competencies may be required of each position.Communication – Ability to communicate effectively both verbally and in writing.Conscientious – Ability to feel obligated to do right or be good along with awareness of one’s own conduct, intentions, or character.Teamwork – Ability to work well in groups, develop and maintain positive working relationships, help resolve conflict, and support team goals.Adaptability – Ability to adapt to change, be open to new ideas, handle pressure and uncertainty, and adjust work plans to meet changing company needs.Trustworthy – Ability to be worthy of confidence and create assured reliance on the character, ability, and truth of own self.Patient Confidentiality – Ability to maintain patient confidentiality, and hold others accountable to such, in accordance with the highest ethical standards.Other dutiesPlease note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.Work environmentWork from home and/or typical office environment.Physical demands/potential hazardsMust be able to sit for prolonged periods, must be able to use eyes, hands, and body to maintain office dexterity and mobility; may be required to lift typical office equipment up to 20 pounds.Travel required0-25% travel required.Education and experienceEducational requirements that are job-related and consistent with business necessityHigh School Diploma or G.E.D. required.Previous medical billing experience with knowledge of billing related reporting.Three to five years’ experience in health-care (billing or clinical).Experience working with medical payers and vision insurance.Demonstrated knowledge of medical terminology with high proficiency in general medical office procedures including HIPAA regulations.Working knowledge of medical billing systems, Nextgen a plus.Working knowledge of CPT and ICD-9 & ICD-10 coding system.Leadership and management experienceLeadership requirements that are job-related and consistent with business necessity N/AAdditional eligibility requirementsWork authorization/security clearance requirementsMust be authorized to work in the USEEO StatementIt is the policy of L.O. Eye Care and its affiliates to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information, or any other protected characteristic under applicable law. This policy relates to all phases of employment, including, but not limited to, recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company-sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the company where appropriate if applicable.