Insurance Verification & Authorization Specialist

Orthowisconsin; City of Pewaukee (WI); Remote; USD 25,000 - 39,000; Full time

Job summary

Orthowisconsin in Pewaukee, WI is seeking a Pre-Authorization Specialist to verify patient eligibility and benefits, secure authorizations, and ensure pre-certifications are met for inpatient, outpatient, and ancillary services. You will coordinate with healthcare providers to secure necessary referrals.

The role requires experience with EHR systems and insurance verification. You will work in an office-based setting, collaborating with patients and clinical staff to ensure timely approvals and

Qualifications

• High School Diploma or equivalent required.
• Minimum two years of experience in medical insurance verification, pre-authorization, or related role.
• Experience in orthopedic or surgical settings preferred.
• Proficiency in using electronic health records (EHR) and insurance verification software.
• Experience using EPIC and Microsoft Office preferred.
• Ability to communicate effectively verbally, nonverbally, and in writing.
• Strong understanding of insurance policies, pre-certification, and authorization processes.

Responsibilities

• Obtain authorizations and pre-determinations from insurance companies for all required services.
• Receive verification of benefits from insurance and confirm patient eligibility via direct communication and online portals.
• Enter new/updated patient information into the computer system; ensure documentation is complete and submitted promptly.
• Determine payer authorization requirements and provide updates on status and issues.
• Track status of pre-authorizations daily; notify administrative staff before due dates.
• Document appropriate information in patient records and ensure referrals are in place where necessary; maintain records of verifications, authorizations, and referrals.
• Liaise with patients, healthcare providers, and insurers to resolve authorization issues.
• Ensure actions comply with hospital policies, state and federal regulations, and insurance guidelines.
• Perform other office duties when backup coverage is needed.

Skills

Communication skills

Attention to detail

Team collaboration

Education

High School Diploma or equivalent

Tools

EPIC

Microsoft Office

EHR software

Job description

Orthowisconsin in Pewaukee, WI is seeking a Pre-Authorization Specialist to verify patient eligibility and benefits, secure authorizations, and ensure pre-certifications are met for inpatient, outpatient, and ancillary services. You will coordinate with healthcare providers to secure necessary referrals.

The role requires experience with EHR systems and insurance verification. You will work in an office-based setting, collaborating with patients and clinical staff to ensure timely approvals and