Remote Authorization Specialist II – Pre-Auth & Payer Support

servcorphr; New York (NY); Hybrid; USD 34,000 - 46,000; Full time

Benefits offered by this job

Healthcare benefits

Paid Time Off

Competitive benefits package

Job summary

61st Street Service Corporation, providing administrative and clinical support for ColumbiaDoctors in the Northeast, seeks an Authorization Specialist II. This primarily remote role requires tri-state residency and occasional office visits for training or meetings.

The specialist verifies insurance benefits, secures pre-authorizations, and collaborates with providers and payers to ensure timely authorizations for procedures, labs, and referrals.

Qualifications

• High school graduate or GED certificate is required.
• A minimum of 1-year experience in a physician’s billing or third payer environment.
• Ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Strong customer service and patient-focused orientation with calm, professional communication.

Responsibilities

• Verifies insurance coverage via system tools, payer portals, etc. and update changes in billing system.
• Configures provider’s participation status with patient’s insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Researches system notes to obtain missing or corrected insurance or demographic information.
• Reviews clinical documentation to insure criteria for procedure meets insurance requirements.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Follows through on pre-certifications until final approval is obtained.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Set up peer to peer calls with clinical providers and insurance companies, as needed.
• Calculate and document patient out of pocket estimates and provide to patient.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization-Referrals Specialist I with complex cases or questions.
• Serves as back-up to Authorization-Referrals Specialist III.
• Performs other job duties as assigned.

Skills

Customer service

Communication skills

Time management

Multitasking

Navigating managed care eligibility

Calm and professional demeanor

Problem solving

Education

High school diploma or GED

Tools

Epic

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

61st Street Service Corporation, providing administrative and clinical support for ColumbiaDoctors in the Northeast, seeks an Authorization Specialist II. This primarily remote role requires tri-state residency and occasional office visits for training or meetings.

The specialist verifies insurance benefits, secures pre-authorizations, and collaborates with providers and payers to ensure timely authorizations for procedures, labs, and referrals.