We are seeking a detail-oriented Authorization Specialist to manage and handle the authorization process for an Orthopedic client. The ideal candidate will ensure timely and accurate insurance authorizations while maintaining compliance with payer guidelines and client requirements.
Key Responsibilities
Manage end-to-end insurance authorization processes for orthopedic procedures, including pre-certifications, prior authorizations and Pre-determination.
Review clinical documentation to ensure it meets payer-specific requirements.
Coordinate with physicians, clinical staff, insurance providers, and internal teams to obtain approvals.
Track authorization status and follow up with payers to prevent delays or denials.
Maintain accurate documentation and update authorization details in internal systems.
Identify and escalate authorization-related issues or risks in a timely manner.
Ensure compliance with HIPAA regulations and organizational policies.
