Medical Authorizations Specialist

A Hospital in Los Angeles is looking for an experienced Medical Authorizations Specialist to support patient access and revenue cycle operations for a healthcare organization. The Medical Authorizations Specialist position focuses on securing timely insurance approvals, insurance verifications confirming coverage details, and helping patients move forward with needed services without unnecessary delays. The Medical Authorizations Specialist candidate brings strong payer knowledge, sound judgment, and a patient-centered approach in a fast-moving hospital or clinical environment.

Responsibilities:

• Manage authorization and precertification requests for scheduled and unscheduled services across a range of government and commercial health plans.

• Confirm active medical insurance coverage, benefit levels, and service-specific requirements before care is delivered to reduce claim and scheduling issues.

• Evaluate provider orders and supporting clinical records to prepare complete submissions that align with payer criteria.

• Track open requests, communicate with insurers, and take timely action to obtain determinations within required turnaround times.

• Share updates on approval, denial, or pending status with care teams, schedulers, physicians, and patients as needed.

• Investigate barriers that could interrupt treatment timelines and work with internal and external parties to resolve them quickly.

• Record authorization activity, follow-up efforts, and outcomes accurately within the electronic medical record and related billing systems.

• Assist with reconsiderations or appeals when requests are postponed or denied, using documentation that supports medical necessity.

• Stay informed on changing payer rules, regulatory expectations, and authorization workflows while protecting patient confidentiality at all times.

• High school diploma or equivalent required.
• At least 2 years of recent experience handling insurance authorizations in a hospital, clinic, medical group, or similar healthcare setting.
• Working knowledge of insurance follow-up, preauthorization processes, medical billing, patient accounting, and medical collections.
• Familiarity with commercial plans, Medicare, Medicaid or Medi-Cal, and managed care benefit structures.
• Ability to verify eligibility, interpret coverage details, and identify payer-specific submission requirements.
• Strong computer proficiency, including experience with electronic medical records and Microsoft Office applications.
• Effective written and verbal communication skills with the ability to prioritize tasks and collaborate across departments.
• Spanish-English bilingual skills or an associate degree in healthcare administration or a related field is preferred.