Patient Access Authorization Specialist

About the role

Verifies insurance eligibility and benefits, ensures correct insurance package registration, and obtains required authorizations/pre-certifications to support timely access to care while meeting payer requirements. Coordinates with patients, providers, front office/clinical teams, and payers to reduce delays and denials.

Key responsibilities

• Use RTE tools and/or payer portals/phone to verify coverage, network/provider participation, benefits, and referral/authorization requirements
• Ensure accurate insurance package registration and documentation in the EHR/authorization system
• Obtain prior authorization/precertification as needed (may include orthopedic-related surgical, PM&R, and ancillary services)
• Review orders/clinical documentation when required for authorization submissions
• Submit authorization requests via payer/vendor portals; follow up on pending requests, medical review, denials, and additional information requests
• Provide TOS estimates (copays/coinsurance/deductibles/out-of-pocket estimates) based on verified benefits
• Escalate complex issues appropriately and communicate status/delays clearly to internal teams
• Support work queues and may assist the Contact Center/answer transferred insurance-related calls as assigned

About you

• Gradudate of any related course
• 2 years experience in prior authorization, pre-certification, and/or insurance verification in a physician office or hospital setting
• Orthopedic experience strongly preferred
• Knowledge of insurance authorization/eligibility processes; familiarity with CPT/ICD-10 and medical terminology
• Proficient with EHR systems, authorization/pre-cert platforms, and payer portals
• Strong communication, organization, and time-management skills
• Willing to work ON-SITE and in a NIGHT SHIFT schedule