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Authorization Processor Jobs in Delaware (NOW HIRING)

Beebe Healthcare

CAT SCAN - DIA SPECIALIST

Lewes, DE · On-site

$17.75 - $27.51/hr

Exam, contrast use, diagnosis and authorization number matching appropriate CPT coding. Request ... A working knowledge of word processing skills and computer operation are beneficial. Competencies ...

TriOptus LLC

Project Manager II

Millsboro, DE · On-site

Project Authorization process as needed * Forecast unique ITNs * Estimated In-Service Reports * Quarterly Work Plan PM experience, excellent communication skills, organized, and able to manage a ...

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Authorization Processor information

Do you need a degree to be a prior authorization specialist?

A prior authorization specialist, or authorization processor, typically does not require a college degree but benefits from relevant experience, strong organizational skills, and knowledge of healthcare policies and insurance procedures. Certification in medical billing or coding can enhance job prospects but is not always mandatory.

What is the difference between Authorization Processor vs Claims Processor?

AspectAuthorization ProcessorClaims Processor
Required CredentialsHigh school diploma or equivalent; certifications like Certified Healthcare Access Associate (CHAA) are commonHigh school diploma or equivalent; certifications like Certified Claims Professional (CCP) are common
Work EnvironmentHealthcare facilities, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or third-party claims processing centers
Job FocusReviewing and authorizing patient services or insurance coverageProcessing and adjudicating insurance claims for reimbursement
Common TasksVerifying coverage, obtaining authorizations, communicating with providersExamining claim details, coding, approving or denying claims

While both roles involve working within healthcare and insurance settings, Authorization Processors focus on approving patient services and verifying coverage, whereas Claims Processors handle the processing and adjudication of insurance claims for reimbursement. Understanding these differences helps in choosing the right career path or job search focus.

Is prior authorization a stressful job?

Authorization processors often work in fast-paced environments where accuracy and efficiency are important, which can lead to stress, especially when dealing with tight deadlines or complex cases. However, stress levels vary depending on workload, support systems, and individual coping skills, and many professionals develop strategies to manage the demands of the role.

What are Authorization Processors?

Authorization Processors are professionals responsible for reviewing, verifying, and processing requests for access, permissions, or approvals, often in banking, insurance, or healthcare industries. Their main duties include checking documentation, ensuring compliance with company policies and regulations, and facilitating the approval or denial of authorization requests. They play a crucial role in preventing unauthorized transactions and maintaining the integrity of sensitive processes. Attention to detail, strong organizational skills, and a solid understanding of regulatory requirements are essential for this position.

What are the key skills and qualifications needed to thrive as an Authorization Processor, and why are they important?

To thrive as an Authorization Processor, you need a keen attention to detail, knowledge of insurance policies, and experience with healthcare or financial authorization processes, often supported by a high school diploma or equivalent. Familiarity with claims management systems, electronic health records (EHR), and insurance verification software is typically required. Strong organizational skills, clear communication, and problem-solving abilities help you efficiently manage requests and collaborate with clients and internal teams. These competencies ensure accurate, timely processing of authorizations, which is critical for preventing delays in patient care or financial transactions.

What jobs in the US pay $300,000 a year?

For an Authorization Processor, reaching a $300,000 annual salary is uncommon, as this role typically offers lower compensation. High-paying jobs in the US that can reach or exceed this level often include executive positions, specialized medical professionals, or senior roles in finance and technology that require extensive experience, advanced skills, and certifications. Salary levels vary based on industry, location, and experience.

How much do precertification specialists make?

Precertification specialists typically earn between $35,000 and $55,000 annually, depending on experience, location, and the employer. They often require strong communication skills and familiarity with healthcare policies and insurance procedures.

What are the most common challenges faced by Authorization Processors, and how can applicants prepare for them?

Authorization Processors often face challenges such as managing a high volume of requests, staying current with shifting insurance policies, and ensuring accuracy under tight deadlines. To prepare, applicants should develop strong organizational skills, attention to detail, and the ability to quickly learn new software or procedures. It's also helpful to familiarize yourself with healthcare terminology and payer requirements, as this knowledge will make it easier to navigate complex authorization cases and communicate effectively with providers and insurance representatives.
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What job categories do people searching Authorization Processor jobs in Delaware look for? The top searched job categories for Authorization Processor jobs in Delaware are:
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Authorization Processor jobs near you
Referral & Authorization Care Coordinator

Referral & Authorization Care Coordinator

Oshi Health

Delaware City, DE • Remote

$47K - $52K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Job description

Referral and Authorization Coordinator

Reports To: Manager, Care Operations
Locations Hiring From: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, Virginia ONLY. Must currently reside and plan on residing in the entire employment.
Schedule: Monday- Friday 12-8pm EST and Monday- Friday 9-5pm EST
Employment Type: Full-Time

Role Overview

As our Care Coordinator specializing in Prior Authorizations & Referrals, you will manage back-office responsibilities including referral management, prior authorizations, specialty pharmacy & infusions, and medical records to help deliver and implement clinical strategies and support member care coordination in collaboration with a multidisciplinary clinical team. You will use a high level of attention to detail, organization, and communication skills to obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met.

What You'll Do: Key Responsibilities

  • Collaborate with a multidisciplinary team of care providers (including NPs, RDs, Behavioral Health Providers) to provide a whole-person approach to member care.
  • Coordinate, track, and communicate patient referrals, prior authorizations, and medical records to promote team awareness and patient safety.
  • Provide complete and accurate registration of referrals and authorizations, including patient demographics, insurance information, and clinical documentation to external providers and specialty pharmacies.
  • Offer proficient knowledge of referrals, insurance requirements, and the prior authorization process to internal and external resources, eliminating barriers to care and following up on progress toward key goals.
  • Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a timely manner while demonstrating understanding of payer medical policy guidelines.
  • Initiate appeals for denied authorizations and maintain close follow-up to ensure positive member outcomes.
  • Engage in external coordination of pharmacy support services to ensure members receive all necessary support throughout the prior authorization process.
  • Assist members in accessing services, providing personalized customer service while maintaining close communication with the care coordination team.
  • Manage key reports and track relevant data to identify successes and drive refinements in operational processes.

What We're Looking For: Qualifications & Requirements

Required

  • Bachelor's Degree in Healthcare administration or equivalent course work
  • Minimum of 2-3 years experience in healthcare coordination, care, or case management within a remote digital healthcare space
  • Completed degree in a health and science related field (biology, psychology, health science, nutrition, nursing, etc.).
  • Fluent in healthcare terminology with a working understanding of clinical concepts.
  • Background knowledge navigating health insurance plans and coverage, with ability to provide benefits breakdown analysis to consumers.
  • Comfortable and competent with common administrative technologies (Zoom, Slack, Office or equivalent), charting electronically in EMR/EHR systems

Preferred

  • Experience working in telehealth or a digital health environment.
  • Strong critical thinking skills with ability to triage accurately and escalate appropriately.
  • Experience in a high-growth startup or mission-driven healthcare organization.

Compensation & Benefits

  • Salary Range: $47,000 – $52,000 (commensurate with experience)
  • Health Benefits: Employer-sponsored medical, dental, and vision coverage
  • Time Off: Unlimited PTO + 11 paid company holidays
  • Retirement: Eligibility to contribute to 401(k)
  • Work Style: Remote-first — work from home anywhere within our approved states
  • Growth: Tailored professional development opportunities as we scale
  • Life Concierge: Access to Overalls, because we know life happens

About Oshi Health

Oshi Health is a virtual digestive health practice on a mission to transform GI care. We combine compassionate, multidisciplinary care with innovative technology to help people with chronic digestive conditions get the answers and relief they deserve. When you join Oshi, you're joining a team and a mission that's changing what great healthcare looks like. Oshi Health is revolutionizing GI care with a digital clinic model that provides easy, convenient access to an integrated and multidisciplinary care team that takes a whole-person approach to diagnosing, managing, and treating digestive health conditions. We take time to get to know each patient, develop a personalized, whole-person care plan that includes identification of symptom triggers and prescription of evidence-based interventions, including medications, dietary changes, and mental health support.

For Every Oshi Team Member We Want:

  • Genuine passion for improving patient lives and transforming GI care
  • Strong communication skills and emotional intelligence
  • Comfort in a fast-paced, remote-first, mission-driven environment
Compensation Range
$47,000—$52,000 USD

Note: This job description serves as a general overview and may be subject to change based on organizational needs and requirements.

Oshi Health is an equal opportunity employer that is committed to creating a diverse work environment. To do that, we champion a workplace where each and every person is treated with dignity and respect and is valued for their unique perspective and contributions.
Oshi Health's policy is to maintain a working environment that encourages mutual respect, promotes harmonious and congenial relationships between employees, and is free from all forms of discrimination and harassment of any employee (or applicant for employment or service provider) by anyone, including supervisors, co-workers, vendors, or clients. Harassment and discrimination in any manner or form is expressly prohibited. There is no tolerance for discrimination or unequal treatment of any kind on the basis of race, color, religion, creed, gender, sex, sexual orientation, gender identity or expression, pregnancy, sexual and reproductive health decisions, national origin, age, disability, genetic information, marital status or civil partnership/union status, familial status, military or veteran status, predisposition or carrier status, domestic violence victim status, alienage or citizenship status, unemployment status, sexual violence or stalking victim status, caregiver status, or any other characteristic protected by law.

This practice applies to all terms, conditions and privileges of employment including, but not limited to, recruitment, selection, promotion, demotion, transfer, layoff, rehire, termination of employment, development and training, compensation, benefits and retirement.

For more information, visit us at www.oshihealth.com

Oshi Health will never contact job candidates via text message or any other messaging platform including WhatsApp, Signal, and Telegram. All official correspondence will occur through email. We will never ask you to share bank account information, cash a check from us, or purchase software or equipment as part of your interview or hiring process. If you have concerns, please reach out to careers@oshihealth.com, and we'll confirm whether you're engaging with one of our Oshi teammates!