Authorization Specialist - Primary Care

Join our brand-new, state-of-the-art medical offices at Buckwalter Place in the heart of the beautiful Lowcountry. 

Location: Novant Health Buckwalter Place Primary Care – Bluffton, SC

Schedule: Full-Time, Monday–Thursday (8:00 AM – 5 PM), Friday (8:30 AM – 1:00 PM) 

This is a full time in person role in Bluffton, SC

As an Authorization Specialist, you will serve as a critical bridge between our clinical care teams, insurance providers, and patients. Your primary mission is to ensure patients receive seamless access to care by securing timely prior authorizations, managing complex insurance workflows, and keeping care moving forward without administrative delays.

• Education: High School Diploma or GED, required.
• Experience: Two years in medical office or referrals, preferred.
• Additional Skills (required):
  
  • Ability to productively work Remote
  • Knowledge of medical office software for the following: updating patient demographic information and processing referrals and medical records.
  • Requires excellent verbal communication skills
  • Must be able to work with changing priorities.
  • Requires excellent organizational, problem solving and critical thinking skills
  • Must be able to interact with individuals of all cultures and levels of authority.
  • Experience handling PHI.
  • Must possess initiative while functioning as part of a remote team
• Additional Skills (preferred):
  • An understanding of CPT and ICD- CM coding processes
  • Proficient with Insurance Authorization Portals.
  • Basic medical terminology required, knowledge can be obtained through formal classes or work experience. High level of working knowledge of EPIC systems. Detailed knowledge of multiple payors’ billing requirements. Familiarity of coding requirements for practice specialty.
  • Proficient in Microsoft office: Teams, Excel and Word.

• Prior Authorization Management: Secure required pre-authorizations and pre-certifications for diagnostic imaging, specialized procedures, pharmaceuticals, and out-of-network referrals.

• Insurance Verification: Verify patient insurance benefits, eligibility, and coverage limitations prior to scheduled appointments and treatments.

• Clinical Documentation Review: Review electronic health records (Epic/MyChart) to ensure clinical documentation accurately meets insurance guidelines and medical necessity criteria.

• Denial Mitigation & Appeals: Investigate, track, and appeal insurance denials or peer-to-peer review requests by coordinating directly with internal providers and medical directors.

• Provider & Team Collaboration: Partner closely with physicians, advanced practice providers (APPs), and clinic administrators to resolve administrative bottlenecks and communicate coverage limitations.

• Patient Communication: Act as an expert resource for patients, clearly explaining insurance requirements, coverage status, and potential out-of-pocket responsibilities.

• Compliance & Accuracy: Maintain complete and accurate data entry within billing systems, strictly adhering to HIPAA regulations and internal revenue cycle protocols.