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Title

Authorization/Eligibility Specialist - NSC 

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.  
Description

JOB SUMMARY:

The Authorization/Eligibility specialist works as a liaison between the Centralized Business Office, the physicians, and the patient. The position interfaces with physicians, patients, and administrative personnel and answers phone calls, responds to fax and email communication and routes messages accordingly. The focus of the position is to obtain prior authorizations for medications and/or procedures. To review patient insurance eligibility and process authorizations to ensure approvals are on file for each patient scheduled to receive services at the Practice. Duties include reviewing insurance information, requesting authorization from insurance carriers, and data entry.

 

JOB RESPONSIBILITES:

  • Generates report from the Practice Management (PM) system to review the patients and services scheduled for the next business day
  • Reviews patient insurance information to verify eligibility for scheduled services such as appointments, testing, and surgery
  • Prints and/or saves eligibility forms for the front desk receptionists at assigned location the day before the appointment date
  • Prepares and requests authorization for scheduled appointments and surgeries prior to the appointment/surgery date
  • Processes any referral authorizations and sends referral requests to referring physician's offices, if needed
  • Reviews all authorizations processed by the Front Desk Receptionists to ensure accuracy and completeness – fixes issues, if any
  • Inputs patient demographics and insurance information into the PM system
  • Troubleshoots any issues with patient eligibility and authorizations by contacting the insurance companies
  • Receives any complex eligibility/authorization issues or questions and processes them accordingly
  • Cancels or reschedules patients based on insurance information, as needed
  • Provides coverage for front desk personnel, as needed
  • Performs various administrative duties such as answering phones, directing calls or messages, accurately entering data into the patient medical records, and transporting files/materials between offices
  • Works overtime as necessary
  • Follows applicable policies and procedures and takes precautions to establish a safe work environment
  • Maintains strict patient protocols in accordance with practice policies/ HIPAA requirements
  • Maintains a high level of professionalism with patients and works to establish a positive rapport
  • Performs other duties as assigned
 
Category Business Support  
Exempt/Non-Exempt Non-Exempt  
Location North Suffolk Cardiology - Cardiology  
Full-Time/Part-Time Full-Time  
Position Requirements

REQUIRED QUALIFICATIONS:

  • Education: High School Diploma or equivalent required
  • Experience: 1-3 years of related medical receptionist and/or related medical insurance/authorization experience required
  • Knowledge of insurance carriers and vision plans such as HMO/IPA, Medicare, Medi-Medi, and VSP required
  • Comfortable using a computer
  • Language: Ability to read, write, and communicate in English; Bilingual in Spanish, a plus
  • License/Certification: None

 

PREFERRED QUALIFICATIONS:

  • EMR experience.
  • Experience with managed care companies.
  • Familiarity with medical terminology, CPT procedure codes, and ICD-10 codes.

 

PHYSICAL DEMANDS:

  • Must be able to sit for long periods of time, and must have manual dexterity to work computer systems and keyboard. It is reasonable to anticipate lifting 10 -15 pounds in any given day.

 

In accordance with the New York State Department of Health (DOH) order that all hospitals and nursing homes “continuously require all covered personnel to be fully vaccinated against COVID-19.”  Upon receipt of a conditional job offer, candidates who are not already vaccinated must obtain the first dose of the vaccine within three (3) calendar days of job offer and must obtain any subsequent doses in accordance with the vaccine protocol. The order allows for limited medical exemptions with reasonable accommodations, consistent with applicable law.

 

 
Shift Days  
Tags Full time, Monday-Friday  
Salary Range $23-$27 per hour  
Position Authorization/Eligibility Specialist - NSC  
Open Date 9/30/2025  

This position is currently accepting applications.

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