Procedure Authorization Specialist

Position Overview

Beverly Hills Center for Digestive Health is seeking a detail-oriented Procedure Authorization Specialist to coordinate insurance authorization and administrative requirements for scheduled diagnostic and gastrointestinal procedures.

This role works closely with patients, providers, clinical staff, scheduling personnel, and insurance companies to help ensure required authorizations and supporting documentation are addressed before scheduled services.

The Procedure Authorization Specialist will review scheduled procedures, verify authorization requirements, submit authorization requests, track pending cases, follow up with insurance payers, and communicate authorization status to appropriate team members.

The ideal candidate is organized, proactive, and comfortable managing multiple cases while working within established healthcare and insurance procedures.

Key Responsibilities

Procedure Authorization

• Review scheduled procedures to identify authorization requirements.
• Coordinate prior authorization requests for eligible diagnostic and gastrointestinal procedures.
• Prepare and submit authorization requests to insurance payers.
• Collect required clinical and administrative documentation for submission.
• Ensure authorization requests contain complete and accurate information.
• Track authorization requests through approval, denial, or additional-information requests.

Insurance Coordination

• Contact insurance companies to verify authorization requirements.
• Review payer requirements and communicate administrative requirements to appropriate staff.
• Document authorization requirements, reference numbers, and payer communications.
• Monitor authorization status and effective dates.
• Identify potential insurance-related delays and communicate them promptly.

Case Follow-Up

• Maintain a tracking system for pending authorization requests.
• Follow up with payers regarding delayed or outstanding requests.
• Respond to requests for additional documentation.
• Coordinate with clinical personnel to obtain required records.
• Monitor scheduled procedure dates to help prioritize time-sensitive requests.
• Escalate unresolved cases according to established procedures.

Documentation Management

• Collect and organize supporting clinical and administrative documentation.
• Review documentation for completeness before submission.
• Upload authorization documents into the appropriate electronic system.
• Maintain organized authorization records.
• Document approval numbers, effective dates, authorized services, and other applicable information.
• Protect confidential patient information.

Provider & Clinical Team Coordination

• Coordinate with physicians, providers, nurses, and clinical staff regarding authorization requirements.
• Request supporting documentation when additional information is needed.
• Communicate authorization status to scheduling and clinical teams.
• Identify missing documentation that could delay a procedure.
• Support timely preparation of cases for scheduled services.

Patient Communication

• Communicate with patients regarding routine administrative requirements when appropriate.
• Request insurance or demographic information when needed.
• Explain general administrative next steps related to authorization.
• Provide updates within the scope of established procedures.
• Direct clinical or complex insurance questions to appropriate personnel.

Scheduling Coordination

• Work closely with procedure scheduling staff.
• Review upcoming schedules and identify cases requiring authorization.
• Communicate approval or pending status before scheduled procedure dates.
• Help prevent avoidable scheduling delays or cancellations related to incomplete authorization requirements.
• Update relevant systems with current authorization information.

Denial & Exception Support

• Document authorization denials and requests for additional information.
• Communicate denials or administrative issues to appropriate personnel.
• Coordinate collection of additional documentation when requested.
• Track resubmissions or follow-up actions according to established procedures.
• Escalate cases requiring clinical review or management intervention.

Data Entry & Reporting

• Maintain accurate authorization logs and tracking records.
• Update patient and procedure information in appropriate systems.
• Prepare routine reports on pending, approved, denied, and completed authorization cases.
• Monitor trends involving recurring payer requirements or authorization delays.
• Support workflow-improvement initiatives.

Qualifications

Required

• High school diploma or equivalent.
• 1–3 years of experience in prior authorization, medical insurance verification, healthcare administration, patient access, medical billing, or a related field.
• Familiarity with health insurance terminology and prior authorization processes.
• Strong organizational and follow-up skills.
• Excellent attention to detail and accuracy.
• Strong written and verbal communication skills.
• Ability to manage multiple cases and deadlines.
• Proficiency with computers, email, spreadsheets, and electronic healthcare systems.
• Ability to maintain confidential patient information.

Preferred

• Experience working in gastroenterology or another outpatient medical specialty.
• Previous experience with procedure or diagnostic-test authorizations.
• Familiarity with commercial insurance, Medicare, Medicaid, and managed-care plans.
• Experience with electronic health records and practice-management systems.
• Knowledge of medical terminology.
• Experience coordinating clinical documentation.
• Previous revenue-cycle or medical billing experience.

Core Competencies

• Prior Authorization
• Procedure Coordination
• Insurance Verification
• Payer Communication
• Healthcare Administration
• Documentation Management
• Case Tracking
• Follow-Up
• Scheduling Support
• Data Entry
• Patient Communication
• Confidentiality
• Organization
• Attention to Detail

Performance Expectations

Success in this role is demonstrated by:

• Timely submission of authorization requests.
• Accurate and complete authorization documentation.
• Consistent follow-up on pending cases.
• Reduced authorization-related scheduling delays.
• Accurate documentation of approvals and payer requirements.
• Effective communication with providers, staff, patients, and insurance representatives.
• Early identification of potential authorization barriers.
• Reliable maintenance of authorization records.

Pay: $25.34 - $30.52 per hour

Benefits:

• 401(k)
• Flexible schedule
• Health insurance
• Paid time off
• Professional development assistance

Work Location: Remote