Healthcare Authorization Specialist - Medical Verifications

Lehigh Valley Health Network; Pottstown (Montgomery County); On-site; USD 42,000 - 54,000; Full time

Job summary

Lehigh Valley Health Network, Inc. is seeking an Authorization Specialist for the LVPG-L Pulmonary and Critical Care Medicine at Lower Pottsgrove. The role focuses on obtaining benefits, authorizations, and efficient communications with insurers and patients to support timely care.

You will collaborate with physicians and office staff to ensure medical necessity is documented, authorizations align with policy, and billing processes run smoothly for accurate reimbursement.

Qualifications

• Minimum qualifications: High School Diploma/GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
• 1 year in a healthcare setting with insurance verification/authorizations.
• Familiarity with billing procedures and payer reimbursement.
• Knowledge of patient rights and HIPAA regulations.

Responsibilities

• Obtains/verify insurance authorizations for procedures and tests.
• Determines authorization needs based on medical necessity and plans.
• Communicates with insurers to verify benefits and pre-certifications.
• Reviews schedules and ensures proper authorizations before patient visits.
• Assists with patient financial responsibility estimates using payer information.

Skills

Insurance verification

Authorization management

Billing procedures

HIPAA knowledge

Utilization management

Payer contracts understanding

Communication with insurers

Education

High School Diploma/GED with healthcare certificate

Job description

Lehigh Valley Health Network, Inc. is seeking an Authorization Specialist for the LVPG-L Pulmonary and Critical Care Medicine at Lower Pottsgrove. The role focuses on obtaining benefits, authorizations, and efficient communications with insurers and patients to support timely care.

You will collaborate with physicians and office staff to ensure medical necessity is documented, authorizations align with policy, and billing processes run smoothly for accurate reimbursement.