Insurance Verification & Prior Authorization Specialist

Job Overview

We are seeking an experienced Insurance Verification & Prior Authorization Specialist to support U.S. healthcare practices with insurance eligibility, benefits verification, and authorization management.

The ideal candidate understands U.S. insurance processes, can communicate confidently with payers, and proactively tracks authorizations to prevent treatment delays and billing issues.

Key Responsibilities

• Verify patient insurance eligibility and benefits through payer portals, EMRs, and phone calls
• Confirm coverage details, including copays, deductibles, coinsurance, limitations, and exclusions
• Determine whether prior authorization or pre-certification is required for services
• Submit and manage prior authorization requests with insurance payers
• Track pending authorizations and proactively follow up until approval or resolution
• Monitor authorized visit limits, expiration dates, and remaining visits
• Obtain and document authorization numbers and relevant payer information
• Communicate with insurance companies to resolve eligibility, authorization, and coverage issues
• Maintain accurate documentation within the EMR/EHR
• Coordinate with providers, front desk staff, billing teams, and patients regarding insurance requirements
• Identify potential coverage issues before appointments to help prevent claim denials and delayed reimbursement
• Maintain organized records and ensure timely completion of verification and authorization tasks

Qualifications

• Previous experience in U.S. healthcare insurance verification and/or prior authorization
• Strong understanding of commercial insurance, Medicare, and Medicaid
• Experience navigating insurance payer portals and contacting payers directly
• Familiarity with EMR/EHR and practice management systems
• Understanding of medical terminology, CPT codes, and basic healthcare billing workflows
• Strong written and verbal English communication skills
• Excellent attention to detail and documentation skills
• Ability to independently manage multiple patients, deadlines, and pending authorizations

Preferred Qualifications

• Experience supporting Physical Therapy, Occupational Therapy, Speech Therapy, Behavioral Health, or other outpatient practices
• Experience managing authorization visit limits and extensions
• Familiarity with denial prevention and revenue cycle workflows

Ideal Candidate

We're looking for someone who is proactive, organized, and accountable. You should be comfortable taking ownership of insurance verification and authorization workflows without needing constant supervision.

You understand that a missed authorization or incorrect benefit verification can directly affect patient care and clinic revenue—and you make sure nothing falls through the cracks.