The Central Authorization Specialist ensures timely and accurate insurance authorizations for ordered procedures and post-operative care. This role validates authorizations, serves as a subject matter expert on precertification and payer requirements, and partners with physician offices to improve authorization accuracy and efficiency. Responsibilities include educating staff, monitoring authorization quality, identifying workflow and process improvements, analyzing denial and billing feedback, and promoting standardized authorization practices across all locations. The position manages a designated caseload while supporting cost-effective care, regulatory compliance, and continuous operational improvement.
- High school diploma required, or an equivalent combination of education and experience.
- 3-5 years of related experience and/or training required.
- Minimum 3-5 years of experience in a medical clinic, hospital, or corporate healthcare setting.
- At least 2 years of healthcare insurance verification and/or medical billing experience.
- Approximately 2-3 years of progressively responsible administrative experience with knowledge of organizational policies, procedures, and operations.
- Strong computer proficiency.
- Knowledge of medical coding and clinical terminology.
- Experience obtaining insurance authorizations for patient treatment plans.
- Ability to interpret RN and physician documentation to secure authorizations.
- Ability to identify and communicate authorization requirements or barriers to clinical staff.
- Ability to interpret insurance records and related documentation.
- Strong organizational and time management skills with the ability to prioritize multiple responsibilities.
- Ability to work independently and exercise sound judgment when interacting with physicians, payers, patients, and families.
- Excellent verbal and written communication skills.
- Strong analytical, data management, interpersonal, and negotiation skills.
- Ability to collaborate effectively with clinicians, finance personnel, and all levels of management.
- Preferred:
- Additional coursework in business, computer science, or healthcare administration.
- Experience in a medical or surgical specialty clinic.
- Working knowledge of hospital operations, utilization management, case management, and managed care reimbursement.
- General understanding of the healthcare revenue cycle, including billing, coding, charge capture, and reimbursement.
Additional Information
- Organization: Corporate Services
- Department: CBO Central Authorization Unit
- Shift: Day Job
- Union Code: Not Applicable