Centralized Authorization Specialist

Cambridge Healthcare Services, LLC; Buena Park (CA); Hybrid; USD 55,000 - 75,000; Full time

Job summary

Cambridge Healthcare Services, LLC is seeking a Centralized Authorization Specialist in Buena Park, CA to manage admissions authorizations and coordinate with insurance providers. You will review benefits, gather documentation, and ensure timely approvals while maintaining compliance with payer requirements.

The role requires 2–3 years in healthcare authorization, knowledge of Medicare/Medicaid guidelines, strong communication, and ability to work remotely in a fast-paced setting.

Qualifications

• Associate’s degree in Healthcare Administration or related field is a plus.
• Minimum of 2-3 years of experience in healthcare authorization management, preferably in a skilled nursing or long-term care setting.
• Familiarity with insurance regulations, payer requirements, and authorization processes.
• Knowledge of Medicare, Medicaid, and commercial insurance guidelines and documentation standards.
• Strong attention to detail and ability to manage multiple authorization requests simultaneously.
• Excellent communication and interpersonal skills with internal teams and insurance representatives.
• Proficiency in using EHR systems and authorization management software.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Knowledge of medical terminology, coding, and documentation requirements related to skilled nursing facilities.
• Ability to work effectively remotely.

Responsibilities

• Review and verify insurance benefits for prospective residents, obtaining necessary authorizations and pre-certifications for admissions and continued stays.
• Coordinate with the admissions team, physicians, and insurance companies to facilitate the authorization process and ensure timely approval.
• Gather and submit required documentation, medical records, and clinical information to support authorization requests, adhering to payer requirements and documentation standards.
• Communicate with insurance representatives, case managers, and utilization review staff to obtain necessary authorizations, address inquiries, and resolve any issues or concerns.
• Monitor and track authorization status, ensuring accurate and up-to-date documentation of approvals and denials.
• Collaborate with facility staff to facilitate smooth transitions and admissions, ensuring all necessary authorizations are in place prior to admission.
• Provide education and guidance to residents and their families regarding insurance coverage, authorization processes, and financial obligations.
• Maintain accurate and organized records of authorization activities, documentation, and communications with insurance providers.
• Stay updated on changes in insurance policies, procedures, and reimbursement guidelines, adapting processes accordingly.
• Assist with billing and coding activities related to authorized services, ensuring accurate and timely submission of claims.

Skills

Healthcare authorization

Communication skills

EHR systems

Regulatory knowledge

Attention to detail

Billing and coding

Education

Associate’s degree in Healthcare Administration

Tools

Authorization management software

Electronic Health Records (EHR)

Job description

The Centralized Authorization Specialist will be responsible for managing the authorization process for admissions, coordinating with insurance providers, and ensuring compliance with payer requirements. This role requires strong communication skills, knowledge of insurance regulations, and the ability to work effectively in a fast-paced environment.

Responsibilities:

• Review and verify insurance benefits for prospective residents, obtaining necessary authorizations and pre-certifications for admissions and continued stays.
• Coordinate with the admissions team, physicians, and insurance companies to facilitate the authorization process and ensure timely approval.
• Gather and submit required documentation, medical records, and clinical information to support authorization requests, adhering to payer requirements and documentation standards.
• Communicate with insurance representatives, case managers, and utilization review staff to obtain necessary authorizations, address inquiries, and resolve any issues or concerns.
• Monitor and track authorization status, ensuring accurate and up-to-date documentation of approvals and denials.
• Collaborate with facility staff to facilitate smooth transitions and admissions, ensuring all necessary authorizations are in place prior to admission.
• Provide education and guidance to residents and their families regarding insurance coverage, authorization processes, and financial obligations.
• Maintain accurate and organized records of authorization activities, documentation, and communications with insurance providers.
• Stay updated on changes in insurance policies, procedures, and reimbursement guidelines, adapting processes accordingly.
• Assist with billing and coding activities related to authorized services, ensuring accurate and timely submission of claims.

Qualifications:

• High school diploma or equivalent (Associate’s degree in Healthcare Administration or related field is a plus).
• Minimum of 2-3 years of experience in healthcare authorization management, preferably in a skilled nursing or long-term care setting.
• Familiarity with insurance regulations, payer requirements, and authorization processes.
• Knowledge of Medicare, Medicaid, and commercial insurance guidelines and documentation standards.
• Strong attention to detail and ability to manage multiple authorization requests simultaneously.
• Excellent communication and interpersonal skills, with the ability to effectively interact with insurance representatives, healthcare professionals, and internal teams.
• Proficiency in using electronic health records (EHR) systems and authorization management software.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Knowledge of medical terminology, coding, and documentation requirements related to skilled nursing facilities.
• Ability to work effective remotely.