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Medical Authorization Specialist Job Description

What does a Medical Authorization Specialist do?

A Medical Authorization Specialist is responsible for obtaining pre-approval from insurance companies for specific medical treatments or tests that have been requested by a patient’s physician. This involves reviewing medical records, interpreting insurance policies and guidelines, and submitting necessary documentation to the insurance company in a timely manner. Additionally, a Medical Authorization Specialist may also assist patients with understanding their insurance benefits and eligibility for certain types of medical procedures. They play a crucial role in ensuring that patients receive necessary medical care while also adhering to insurance company policies and procedures.

Our Medical Authorization Specialist job description includes the Medical Authorization Specialist responsibilities, duties, skills, education, qualifications, and experience.

Medical Authorization Specialist Example

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If you need an example job description for a Medical Authorization Specialist download the one below, alternatively we have many other Office Administration job description samples and a job description library with over 3000 job descriptions templates that you can download for free.

What does a Medical Authorization Specialist do?

A Medical Authorization Specialist is responsible for managing and processing authorizations for medical treatment, services and supplies. They review requests for medical treatments and services to ensure they are medically necessary, align with established standards and are approved within the required timeframes. They also respond to inquiries from patients, providers and carriers and document authorization requests and decisions. The Medical Authorization Specialist must possess excellent customer service skills, knowledge of medical terminology and regulations and be able to navigate various software systems.

Medical Authorization Specialist Role Purpose

The purpose of a Medical Authorization Specialist is to ensure that patients receive the appropriate medical care and treatment, in accordance with the patient's wishes and the healthcare provider's protocols. This involves working with both the patient and their healthcare provider to assess the various treatment options available, and to secure the necessary authorizations for any treatments that require prior authorization. The specialist is responsible for verifying the patient's eligibility for services, obtaining and submitting the necessary documentation to the payer, negotiating the payment arrangements, and ensuring that all paperwork is correctly completed and submitted in a timely manner. The specialist must also remain up-to-date on changes in the healthcare industry, and work to ensure that the patient receives the best possible care.

Medical Authorization Specialist Role

A Medical Authorization Specialist is responsible for obtaining and verifying authorization from insurance providers for medical services and procedures. The role involves reviewing medical records, collecting and submitting claims, managing pre-authorization requests, and resolving any discrepancies. The specialist should also have an excellent understanding of the insurance authorization process and have excellent communication and problem-solving skills.

Medical Authorization Specialist Duties

  • Responsible for verifying medical authorizations for services, supplies, and medications in accordance with established policies and procedures
  • Analyse medical documentation and process authorizations for services, supplies, and medications
  • Maintain accurate documentation of authorizations and other related records
  • Verify insurance benefits, obtain authorization numbers, and ensure authorization criteria is met
  • Communicate with insurance providers, healthcare providers, and other members of the healthcare team
  • Assist with customer service inquiries related to authorizations
  • Maintain knowledge of changes in insurance policies and procedures

Medical Authorization Specialist Requirements

  • Excellent customer service, communication and interpersonal skills
  • Proficiency in computer skills and data entry
  • Ability to work independently and manage time effectively
  • Ability to maintain a high degree of confidentiality
  • Knowledge of medical terminology and insurance guidelines

Medical Authorization Specialist Skills

  • Excellent communication and interpersonal skills
  • Attention to detail
  • Ability to work independently
  • Ability to handle confidential information
  • Knowledge of medical terminology

Medical Authorization Specialist Personal Traits

  • Organised
  • Attentive to detail
  • Able to work with sensitive information
  • Good communication skills

How to write a Medical Authorization Specialist Job Advert

Use our job advert template to write a job advert for posting on job sites and job boards. Our job advertising templates are carefully created to help you reach your audience and beat the competition to the best talent.

A job description informs the reader about a job, whereas a job advert’s main objective is to sell the job opportunity to attract as many suitable applicants possible. A job advert maybe the first touch-point a candidate has with your company so it is important to create a great impression.

Job Advertisements should enticing, so considering using short, exciting language which get the reader’s attention.

How to write a Medical Authorization Specialist Job Description

To write a job description, we recommend starting with a job description template from our job description library, which contains examples for 800+ positions and professions. Our job description examples include a job summary with duties and responsibilities and skills and requirements, which can be personalised for your job vacancy.

Job Description Advice - Guidance on How to Personalise a Medical Authorization Specialist Job Specification

The hiring process and recruiting new employees to fill your key roles requires a degree of personalisation if you are to attract the best employees in a competitive employment market. The right person for a crucial role or more senior roles will likely have other employers targeting them. As your job description will be the first point of contact, you need to nail your pitch and provide the best possible service.

Job Description Tips - Help on formatting a Medical Authorization Specialist Job Specification

When creating your bespoke description and advert, you should cover and promote these points:

Job title: This should accurately reflect the role and include keywords that top talent might be using to search for jobs.

Job duties: The day to day duties, such as administrative tasks, which vary depending on the company and inform the candidate if they can complete the role.

Technical skills: These are the hard skills required through training, such as proficiency with Microsoft Office.

Soft skills: These include the interpersonal skills and general abilities the right candidates will possess. For example, the competency to prioritise multiple tasks, handle customer queries and customer complaints, work alone, or build a good relationship with coworkers.

The company's culture: Highlighting your company culture and values ensures employees thrive and find outstanding job satisfaction. Candidates that are not the right fit won’t waste their time completing the application process, meaning you can focus on qualified individuals and hire in a more timely manner.

Career progression: Including the career path will entice candidates looking for career growth. 

Training and development programs: Smaller companies may need employees with previous experience or provide educational assistance over internal training offered by larger organisations with more significant resources. 

Employee benefits: Compensation and benefits often fail to appear in job ads and while you may want to hold your cards close to your chest, failing to include them is a mistake. Consider answering common questions, such as working hours and paid leave. Researching the average salary for the role in these early stages will ensure you don’t waste your interviewer’s and the candidate’s time.

Skill gaps: Your company may need to bring in new skills beyond those required to complete the key role and duties. Thinking on an organisational level can be beneficial when contemplating skills diversity.

Legal requirements: Ensure your job advert and description does not ask for inappropriate or discriminatory personal details, such as age, marital status, or religion.

How to Hire a Medical Authorization Specialist

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