What does an authorization representative do?

Authorization representatives get approvals from insurance companies before patients receive care, helping patients and the facility avoid unexpected bills and payment denials.

For example, if a doctor orders an MRI, the representative verifies the patient’s insurance coverage and submits the necessary medical notes to the insurer. The representative might also call the insurer to check on the status. Once approved, the authorization representative updates the patient’s file so the MRI can be scheduled.

Authorization representative skills and qualifications

Quality authorization representatives are often organized, critical thinkers and comfortable with detailed, process-driven work, such as data entry.

You might list these skills in your authorization representative job description:

• Ability to accurately record patient names, policy numbers, medical codes and birthdates
• Determination to follow up with insurance companies regarding outstanding requests
• Communication skills to speak professionally with insurance agents, nurses, doctors and patients
• Organizational skills to manage multiple cases simultaneously and monitor deadlines and requirements
• Basic understanding of medical and insurance terminology

Authorization representative experience requirements

A skills-first hiring approach works well for this position because many administrative or customer service roles, such as a customer service representative or help desk clerk, can help employees develop important skills for the job.

Consider candidates with experience in medical billing, patient registration or insurance administration. Applicants with a background in recordkeeping, such as a medical office assistant, may succeed in this job.

Authorization representative education and training requirements

Formal education isn’t typically required for authorization representatives. You can focus on a candidate’s practical skills rather than their degrees or experience, since most training can be on-the-job. Your new hire will likely learn the specific rules of insurance plans, how to use your EHR system, the billing software and the clinic’s internal workflows.

Candidates with a medical billing or coding certificate may demonstrate helpful knowledge. Examples may include the Certified Professional Coder (CPC) or the Certified Billing and Coding Specialist (CBCS) designations.

Job description samples for similar positions

If this authorization representative job description doesn’t align with your company’s needs, you can explore these descriptions for other healthcare administrative roles:

• Insurance agent
• Patient access representative
• Medical biller
• Medical coder