Insurance Authorizations Specialist 25-00522
Alura Workforce Solutions
Mission Viejo, CA
Insurance Authorizations Specialist
Position Type: Temporary/Temp-Hire
Schedule: M-F, 25 hours/week (Part Time)
Assignment Length: Approximately 6-Months, possibly longer.
DESCRIPTION
Our client is a leading provider of advanced surgical care, offering comprehensive services in general surgery, colorectal surgery, and minimally invasive procedures. The Insurance Authorization Specialist is responsible for coordinating and obtaining insurance authorizations for surgical procedures, diagnostic imaging, and office visits. This role requires in-depth knowledge of medical terminology, insurance plans (HMO, PPO, Medicare, etc.), and prior authorization workflows. The specialist will serve as a key liaison between patients, providers, and insurance companies to ensure timely and accurate approvals that support uninterrupted patient care.
Key Responsibilities
Obtain prior authorizations for surgeries, imaging studies (MRI, CT, etc.), and specialty consultations.
Verify patient insurance eligibility and benefits for upcoming services.
Communicate with insurance carriers to confirm coverage criteria and authorization requirements.
Submit clinical documentation, CPT/ICD-10 codes, and medical necessity information as required.
Track and follow up on pending authorizations to ensure timely approval and scheduling.
Collaborate with physicians, surgery schedulers, and billing staff to provide updates on authorization status.
Document all authorization activities clearly and accurately in the EHR and scheduling systems.
Inform patients of authorization status and any patient responsibility or out-of-pocket estimates.
Assist in resolving denied or delayed authorizations, including appeal submissions when necessary.
Maintain up-to-date knowledge of payer guidelines, pre-certification requirements, and policy changes.
Qualifications
High School Diploma or equivalent required; Associate degree or certification in medical billing or healthcare administration preferred.
Minimum 2 years of experience in insurance authorization or medical billing in a surgical or specialty medical office.
Strong knowledge of insurance plans (PPO, HMO, Medicare, Medi-Cal, Workers' Compensation).
Proficiency in EHR systems and medical billing software.
Working knowledge of CPT, ICD-10 coding, and authorization workflows.
Excellent organizational skills and attention to detail.
Strong communication and customer service skills.
Ability to multitask in a fast-paced environment and meet tight deadlines.
- Bilingual (English/Spanish) a plus, but not required.
INDH