[Hiring] Authorization Specialist @FGC+

Role Description

Be part of a team that helps patients access the healthcare services they need! As an Authorization Specialist, you will play a vital role in bridging the gap between patients, healthcare providers, and insurance companies. You will review clinical documentation, coordinate authorizations and referrals, and work directly with insurance providers to secure medical necessity approvals. Through your attention to detail and effective communication, you will help ensure patients receive timely access to appropriate healthcare services while supporting providers in delivering quality care.

• Manage and process daily authorization requests from healthcare providers and facilities, ensuring timely and accurate completion.
• Initiate authorization requests through various insurance portals and direct communication with insurance companies.
• Follow up on pending authorizations, track their status, and address any delays or concerns.
• Prepare and process appeals for denied authorization requests.
• Advocate for patients and providers by coordinating with insurance companies to secure approvals across different levels of care.
• Collaborate with healthcare providers to obtain necessary documentation and clarify medical necessity requirements.
• Respond to inquiries from insurance companies, document relevant information, and communicate updates to providers.
• Review and interpret medical records to identify relevant clinical information needed for authorization requests.
• Maintain accurate account records and update documentation in accordance with client guidelines and established processes.
• Ensure all required forms, logs, and reports are completed accurately, thoroughly, and on time.

Qualifications

• Previous experience in healthcare accounts, medical-related projects, or a similar field.
• Experience in Pre-Authorization, Utilization Review, or Case Management is a strong advantage.
• Strong probing, critical-thinking, and problem-solving skills to assess clinical information and address authorization concerns effectively.
• Ability to read, understand, and identify relevant information from medical records and clinical documentation.
• Excellent verbal and written communication skills, with the ability to communicate professionally with healthcare providers, insurance companies, clients, and colleagues.
• Strong attention to detail and accuracy when handling documentation, authorization requests, and account updates.
• Ability to prioritize, organize, and manage multiple tasks while meeting deadlines.
• Proficiency in general computer applications, particularly Microsoft Word, Excel, and PDF tools.
• Ability to quickly learn and navigate new software systems and applications.
• Ability to work independently and collaborate effectively as part of a team.
• Flexibility and adaptability in a fast-paced environment with changing priorities and processes.

Company Description