Authorization Specialist

Authorization Specialist

Westchester Medical Center Health Network

Job Summary

The Authorization Specialist is responsible for performing complex clerical procedures related to verifying insurance information and obtaining authorization for inpatient admissions and specialized clinical procedures and treatments in accordance with established rules, procedures, specified time frames, and regulatory requirements. The specialist processes clinical information in a timely manner to prevent treatment delays and to avoid denials from third‑party payers and maintains confidentiality of patient information.

Responsibilities

• Enter and retrieve information from various automated systems and prepare specialized reports.
• Ensure completion of Medicare Physician Certification according to regulatory timelines.
• Collect demographic and insurance data and enter accurately into automated systems.
• Prepare, review for completion, and maintain required documents in accordance with established procedures, time frames and regulatory requirements.
• Contact individuals to obtain missing information for incomplete forms.
• Advise patients and clinical staff of problems with insurance authorizations and resubmit requests with additional or revised information.
• Contact insurance providers to confirm level of benefits for inpatient admissions.
• Respond to customer inquiries and provide information.
• Serve as liaison between physician offices, patients, case management department, and Patient Registration.
• Follow up with patients, physicians, clinical and ancillary departments to ensure optimum delivery of services.
• Communicate with case managers, hospital personnel, and external agencies to provide information or resolve discrepancies.
• Perform other duties as assigned.

Qualifications / Requirements

• Two to three years of clerical experience in healthcare or a related field.
• High school diploma or equivalency required; Associate’s degree preferred.
• No licenses or certifications required.

Seniority Level

Entry level

Employment Type

Full‑time

Job Function

Other

Industries

Hospitals and Health Care

Location

White Plains, NY

Other locations: New York, NY; Stamford, CT