Position: Medical Authorization Specialist

Hours: Full-Time

Start Date: Immediate

Job Overview:

We are seeking a dedicated and experienced Medical Authorization Specialist to join our team. The adecuado candidate will be responsible for obtaining prior authorizations for medical services, surgeries, imaging, durable medical equipment (DME), injections, physical therapy, and other specialty services. A strong understanding of medical terminology, insurance company protocols, and U.S. healthcare authorization requirements is essential. Experience in orthopedics and familiarity with Eclinical EHR is highly desirable.

Key Responsibilities:
- Obtain prior authorizations for office visits, surgeries, imaging, injections, DME, physical therapy, and specialty services.
- Verify patient eligibility, benefits, and authorization requirements with insurance companies and IPAs.
- Submit and monitor authorization requests through payer portals, phone, and fax.
- Follow up on pending authorizations to ensure timely approvals.
- Communicate authorization status with patients, providers,



surgery schedulers, referral coordinators, and clinic staff.
- Intake of all calls related to authorizations.
- Review medical records to ensure documentation supports authorization requests.
- Resolve authorization denials and requests for additional clinical information.
- Utilize Eclinical EHR to document authorization activity accurately.
- Maintain excellent turnaround times while managing a high-volume workload.
- Provide exceptional customer service while working collaboratively with internal departments.

Qualifications:
- Minimum 2 years of experience in medical prior authorizations for a U.S. medical practice.
- Fluent in both English and Spanish (required).
- Strong knowledge of commercial insurance, Medicare, Medicaid/Medi-Cal, HMOs, PPOs, Workers' Compensation, and IPA authorization processes.
- Understanding of medical terminology.
- Experience working with payer portals and insuranc

📌 Medical Authorization Specialist (México)
🏢 LA BONE & JOINT INSTITUTE
📍 México