Authorization Specialist - Healthcare

The Authorization Specialist is responsible for accurately identifying, submitting, tracking, and documenting insurance authorizations for physical therapy services. This role requires a strong understanding of insurance authorization processes, keen attention to detail, and a commitment to timely, compliant documentation. The Authorization Specialist supports clinical and administrative staff by ensuring that all patient visits are properly authorized and documented to avoid denials and treatment disruptions. This position is essential to maintaining revenue cycle integrity and ensuring that patient care proceeds with full insurance coverage.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities as management may deem necessary from time to time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Identify patients requiring insurance authorization by auditing patient files and pulling relevant reports.
• Submit accurate and timely authorization requests, including additional visit requests, start date modifications, and expiration extensions, while following payer-specific protocols (e.g., ASH, OPAP, Carelon, MDIPA, Highmark, etc).
• Use evaluative notes in chronological order, adjusting dates when necessary to support authorization submissions when re-evaluations are missing.
• Double-check visit counts and date ranges to prevent gaps or overlaps in authorized care.
• Avoid requesting unauthorized codes (e.g., initial evals for ASH) and adhere to insurance-specific submission guidelines.
• Document each submission in both the authorization spreadsheet and patient chart, including the number of visits requested, start / end dates, and the DOS of the supporting eval or re-eval note.
• Retrieve and upload all authorization responses, including approvals and denials, to patient charts and the appropriate lockboxes; update the auth spreadsheet and sync visits accordingly. Immediately notify the Front Office Coordinator (FOC) and Regional Office Manager (ROM) of any denials to prevent uncovered visits.
• Carefully audit charts to ensure authorizations are accurately linked to each date of service (DOS); apply retroactive authorizations as needed using proper syncing protocols.

Requirements

EDUCATION AND EXPERIENCE

Benefits