Authorization Specialist

Primary Responsibilities
Verify insurance eligibility and benefits
Obtain initial and ongoing prior authorizations
Submit authorization requests and required supporting documentation
Track authorization effective and expiration dates
Track approved visits, hours, and units
Monitor utilization against authorized units
Request authorization extensions and additional units before expiration
Verify authorization numbers and payer requirements
Maintain authorization information in company systems
Review schedules against authorized services
Identify unauthorized or over-utilized visits before billing
Reconcile authorization information with EVV and billing
Follow up with insurance companies on pending authorization requests
Document payer calls, reference numbers, status, and follow-up dates
Notify Scheduling and Clinical staff of authorization limitations
Immediately escalate authorization issues that could affect patient services or payment
Maintain authorization tracking reports
Assist Billing with authorization-related claim denials