Authorizations Specialist (WFH)

FGC+; United States; Remote; USD 52,000 - 76,000; Full time

Job summary

FGC+ is seeking an Authorization Specialist to streamline patient access to care by coordinating authorizations with providers and insurers. You will review clinical documentation, initiate requests, monitor status, and process appeals.

You will collaborate with clinicians and insurance companies to ensure medical necessity and timely approvals, maintain records, and support multiple care levels in a fast-paced environment.

Qualifications

• Experience in healthcare authorization processes or related projects.
• Familiarity with pre-authorization, utilization review, or case management preferred.
• Ability to interpret clinical information and extract relevant data.
• Excellent written and verbal communication with providers and insurers.
• Strong attention to detail and organizational skills.

Responsibilities

• Manage and process daily authorization requests from providers and facilities.
• Initiate authorization requests through insurance portals and communications.
• Follow up on pending authorizations and track status.
• Prepare and process appeals for denied requests.
• Advocate for patients and providers to secure approvals across care levels.
• Collaborate with providers to obtain necessary documentation.
• Respond to inquiries from insurance companies and document updates.
• Review medical records to identify information needed for authorization.
• Maintain accurate account records and update documentation per guidelines.
• Ensure all forms, logs, and reports are completed accurately and on time.

Skills

Healthcare accounts

Pre-Authorization

Utilization Review

Case Management

Communication skills

Reading medical records

Attention to detail

Multitasking

Team collaboration

Adaptability

Tools

Microsoft Word

Excel

PDF tools

Job description

About the Job:

Be part of a team that helps patients access the healthcare services they need! As an Authorization Specialist, you will play a vital role in bridging the gap between patients, healthcare providers, and insurance companies. You will review clinical documentation, coordinate authorizations and referrals, and work directly with insurance providers to secure medical necessity approvals. Through your attention to detail and effective communication, you will help ensure patients receive timely access to appropriate healthcare services while supporting providers in delivering quality care.

What You’ll Do:

• Manage and process daily authorization requests from healthcare providers and facilities, ensuring timely and accurate completion.
• Initiate authorization requests through various insurance portals and direct communication with insurance companies.
• Follow up on pending authorizations, track their status, and address any delays or concerns.
• Prepare and process appeals for denied authorization requests.
• Advocate for patients and providers by coordinating with insurance companies to secure approvals across different levels of care.
• Collaborate with healthcare providers to obtain necessary documentation and clarify medical necessity requirements.
• Respond to inquiries from insurance companies, document relevant information, and communicate updates to providers.
• Review and interpret medical records to identify relevant clinical information needed for authorization requests.
• Maintain accurate account records and update documentation in accordance with client guidelines and established processes.
• Ensure all required forms, logs, and reports are completed accurately, thoroughly, and on time.

What You’ll Bring:

• Previous experience in healthcare accounts, medical-related projects, or a similar field.
• Experience in Pre-Authorization, Utilization Review, or Case Management is a strong advantage.
• Strong probing, critical-thinking, and problem-solving skills to assess clinical information and address authorization concerns effectively.
• Ability to read, understand, and identify relevant information from medical records and clinical documentation.
• Excellent verbal and written communication skills, with the ability to communicate professionally with healthcare providers, insurance companies, clients, and colleagues.
• Strong attention to detail and accuracy when handling documentation, authorization requests, and account updates.
• Ability to prioritize, organize, and manage multiple tasks while meeting deadlines.
• Proficiency in general computer applications, particularly Microsoft Word, Excel, and PDF tools.
• Ability to quickly learn and navigate new software systems and applications.
• Ability to work independently and collaborate effectively as part of a team.
• Flexibility and adaptability in a fast-paced environment with changing priorities and processes.