Authorization Specialist - USFTGP UMSA Front End

The Authorization Specialist is responsible for coordinating and securing insurance pre‑certifications and pre‑authorizations for medical procedures, outpatient testing, and prescribed medications. This role serves as a liaison between providers, insurance carriers, patients, and external agencies to ensure timely access to care while maintaining complete and accurate documentation within the electronic medical record (EMR). The Authorization Specialist supports continuity of care by facilitating appointments, triaging patient communications, and assisting with peer‑to‑peer reviews to resolve authorization barriers efficiently.

What you will do

• Obtain pre‑authorizations and pre‑certifications for procedures, outpatient testing, and medications in accordance with payer guidelines and organizational policies.
• Collect, review, and submit relevant clinical and demographic information required to initiate authorization requests.
• Coordinate authorization workflows between referring providers, insurance carriers, and internal clinical departments to ensure timely scheduling of services.
• Schedule outpatient diagnostic testing and procedures with internal and external providers as directed.
• Maintain accurate and detailed documentation in the EMR, including procedure details, benefits information, authorization numbers, and payer communications.
• Transcribe, triage, and route patient calls and messages to appropriate clinical staff or providers in a timely manner.
• Assist and educate patients regarding authorization requirements, scheduling steps, and insurance processes to reduce delays in care.
• Develop and maintain effective working relationships with physicians, insurance representatives, and external agencies to support continuity of care.
• Compile and submit required documentation for peer‑to‑peer reviews, appeals, or medical necessity determinations.
• Monitor authorization statuses, follow up on pending requests, and proactively resolve incomplete or denied authorizations to minimize care delays.

Education Qualifications

• High School Diploma or GED

Experience Qualifications

• Six (6) months medical office experience to include auth/pre-cert.
• Knowledge of medical terminology, CPT & ICD-9 coding.
• Excellent communication skills

Skills and Abilities

• Understanding of pre‑certification, prior authorization, and referral requirements across various payer types, including commercial, Medicare, and Medicaid plans.
• Ability to accurately document clinical, insurance, and authorization details in an electronic medical record to ensure compliance and continuity of care.
• Strong written and verbal communication skills to interact effectively with physicians, insurance carriers, patients, and external healthcare organizations.
• Ability to educate and guide patients through complex authorization processes while delivering a positive, supportive patient experience.
• Ability to manage multiple authorizations, appointments, and deadlines simultaneously in a fast‑paced clinical environment.
• Skill in gathering medical necessity documentation, identifying authorization barriers, and supporting peer‑to‑peer review coordination for timely resolution.