Benefits Verification and Auth Specialist

Key Responsibilities

• Verify patient insurance coverage, eligibility, and benefits prior to services.
• Determine patient responsibility for copays, deductibles, and coinsurance.
• Obtain required prior authorizations from payers for services, procedures, or medications.
• Document benefit verification and authorization details accurately in the system.
• Collaborate with scheduling, billing, and AR teams to ensure accurate workflows.
• Communicate clearly, providers, and payers regarding authorization status.
• Monitor and track pending authorizations; follow up to prevent delays.
• Identify trends in benefit issues or authorization delays and escalate as needed.
• Support denial prevention efforts by ensuring all payer requirements are met upfront.

Minimum Requirements

• 1–2 years of experience in benefit verification, medical insurance, or prior authorization.
• Strong knowledge of commercial and government payers, insurance policies, and healthcare terminology.
• Excellent attention to detail and organizational skills.
• Strong communication skills with ability to work across patients, providers, and payers.
• Experience with RCM systems and EMRs
• Familiarity with payer authorization portals and workflows.
• Knowledge of denial management and insurance appeal processes.