Healthcare Authorization Specialist

Lehigh Valley Hospital, Inc.; Allentown (Lehigh County); On-site; USD 42,000 - 54,000; Full time

Job summary

Lehigh Valley Health Network in the Lehigh Valley seeks a detail‑oriented insurance verification and authorization specialist. You will obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, and referrals as part of daily operations.

Collaborate with physicians and staff to determine medical necessity, verify insurance, communicate with carriers, and ensure timely payments. Strong knowledge of HIPAA and payer guidelines is essential in this role.

Qualifications

• High School Diploma or GED with specialized training in insurance, coding, billing, or similar healthcare certificate.
• At least 1 year in a healthcare setting with insurance verification/authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and HIPAA regulations.
• Proficient in utilization management processes and managed care.
• Proficient in standard medical practices and insurance benefit structures.
• Preferred: Associate’s Degree.

Responsibilities

• Collaborates with physicians and office staff to determine required authorization based on medical necessity.
• Performs medical necessity checks to confirm support for procedures and diagnoses.
• Ensures authorizations comply with policy and communicates exceptions to relevant parties.
• Communicates with insurance companies to verify benefits and obtain precertification.
• Verifies additional clinical information and referrals.
• Reviews schedules to confirm proper authorization prior to patient visits.
• Assesses patient financial responsibility using verification data and payer contracts.

Skills

Insurance verification

Authorization processes

HIPAA knowledge

Billing procedures

Utilization management

Healthcare terminology

Education

High school diploma or GED

Associate’s degree

Job description

Lehigh Valley Health Network in the Lehigh Valley seeks a detail‑oriented insurance verification and authorization specialist. You will obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, and referrals as part of daily operations.

Collaborate with physicians and staff to determine medical necessity, verify insurance, communicate with carriers, and ensure timely payments. Strong knowledge of HIPAA and payer guidelines is essential in this role.