Remote Authorization Specialist III — Pre-Certs & Appeals

61st Street Service Corporation; United States; Remote; USD 40,000 - 51,000; Full time

Benefits offered by this job

Healthcare

Paid Time Off

Job summary

The 61st Street Service Corporation is seeking an Authorization Specialist III to verify insurance benefits, obtain pre-authorizations, and support management with training and audits. This role focuses on securing payer approvals prior to patient visits and coordinating with clinical staff and payers.

Primarily remote with occasional on-site meetings in the Tri-State area (NY/NJ/CT). Candidates must reside in the region and have at least 2 years in physician billing; CPC is a plus.

Qualifications

• HS diploma or GED required.
• Minimum 2 years’ experience in physician billing/third payer environment.
• Ability to understand managed care eligibility and pre-authorizations.
• Strong customer service and patient-focused orientation.
• Effective verbal and written communication skills.
• Ability to multi-task, prioritize, document, and manage time.
• Familiarity with Microsoft Word, Excel, and Outlook.
• Knowledge of medical terminology.
• CPC certification preferred.
• Experience with Epic or other electronic billing systems preferred.
• Academic healthcare setting experience preferred.

Responsibilities

• Verify insurance coverage via payer portals and real-time eligibility.
• Update billing system with coverage changes.
• Confirm provider participation with plans.
• Determine payer authorization requirements.
• Research notes to obtain missing information.
• Review clinical documentation for insurance criteria.
• Initiate authorizations and submit documentation.
• Follow through on pre-certifications to final approval.
• Manage faxes, emails, and calls; respond to voicemails.
• Communicate with surgical coordinators on authorizations.
• Submit appeals for denials.
• Set up peer-to-peer calls.
• Calculate and document patient out-of-pocket estimates.
• Assist supervisor with special projects.
• Assist with training materials.
• Distribute daily workload.
• Monitor and replenish office supplies.
• Assist management with quality audits.
• Perform other duties as assigned.

Skills

Customer service

Communication

Time management

Education

High school diploma or GED

Certified Professional Coder (CPC)

Tools

Epic

Job description

The 61st Street Service Corporation is seeking an Authorization Specialist III to verify insurance benefits, obtain pre-authorizations, and support management with training and audits. This role focuses on securing payer approvals prior to patient visits and coordinating with clinical staff and payers.

Primarily remote with occasional on-site meetings in the Tri-State area (NY/NJ/CT). Candidates must reside in the region and have at least 2 years in physician billing; CPC is a plus.