Authorization Specialist (Ground Ambulance)

SUMMARY:

This position is responsible for obtaining, verifying, and documenting insurance authorizations, notifications, and referrals for ground ambulance transports in support of the Revenue Cycle department. This position is performed in a fully remote work environment. The Authorization Specialist works with payers, facilities, dispatch, and billing to secure approval for non-emergency, scheduled, and inter-facility transports before service whenever possible, and to resolve retrospective authorization needs promptly after service. These efforts help ensure claims are properly supported and prevent denials related to missing authorizations. This role requires the ability to work independently, manage time effectively, and maintain HIPAA-compliant data security while operating outside a traditional office setting.

ESSENTIAL DUTIES AND RESPONSBILITIES:

• Reviews transport requests and trip schedules to identify which patients and payers require prior authorization, notification, or referral, including HMO, Medicaid managed care, Medicare Advantage, and commercial plans.
• Verifies patient eligibility, benefits, and network status for the date of service through payer portals and eligibility tools, and confirms the correct payer, plan, and member information before requesting authorization.
• Submits authorization requests by phone, fax, and payer portal with the required clinical and transport information, including level of service, origin and destination, diagnosis, medical necessity, and requested number of trips or date range.
• Supports prior authorization requirements for repetitive scheduled non-emergency transports, such as dialysis and other recurring trips, where applicable, and tracks approved visit counts and expiration dates to prevent lapses.
• Obtains and files supporting documentation, including physician certification statements (PCS), physician orders, and facility records, and requests missing information from facilities, physicians, and crews.
• Monitors pending requests through payers to final determination, follows up with payers on a defined schedule, and records authorization numbers, approved dates, units, and level of service accurately in the billing system.
• Manages emergency and urgent transports by completing required payer notifications and post-service authorization or retrospective review requests within payer deadlines.
• Reviews authorization denials and partial approvals, determines the reason, and pursues peer-to-peer reviews, reconsiderations, and appeals with supporting clinical documentation.
• Communicates authorization status, approvals, and denials to billing, dispatch, and facility staff so that claims are billed with correct authorization information, and unauthorized transports are flagged before service when possible.

• Tracks and trends authorization approvals, denials, and turnaround times by payer and facility, and identify recurring requirement changes or denial causes; communicates findings and recommended process improvements to their manager.

• Maintains and updates the department's payer authorization contact list and payer-specific requirements, and shares changes with the billing team.
• Provides clear, timely documentation of all authorization activities within the billing system.
• Responds to facility, provider, and patient inquiries regarding authorization status through phone, email, secure messaging, and portal correspondence.
• Follows applicable HIPAA requirements and company privacy and security policies when accessing, using, and disclosing protected health information (PHI), including maintaining a secure remote work environment and utilizing company-approved systems for handling PHI.
• Utilizes remote collaboration tools (video conferencing, instant messaging, shared dashboards) to stay connected with the billing team and management and proactively communicates any connectivity or equipment issues that may affect productivity.

• Performs other related duties and responsibilities as assigned.

KNOWLEDGE AND SKILLS:

• Strong attention to detail, follow-through, and continuous focus on quality.
• Working knowledge of prior authorization, notification, and referral processes for Medicare Advantage, Medicaid managed care, HMO, and commercial payers.
• Understands ground ambulance services, including emergency versus non-emergency transports, levels of service (BLS, ALS, SCT), and medical necessity and documentation requirements.
• Familiarity with HCPCS transport and mileage codes, ICD-10 diagnosis codes, and how authorization information affects claim submission and payment.
• Experience using payer portals, eligibility verification tools, and authorization tracking systems.
• Proficient with computers, office equipment, and standard billing/practice management software, as well as remote work technology (VPN, video conferencing, secure messaging, cloud-based document sharing).
• Outstanding written and verbal communication skills, including professional phone and video etiquette when working with payers, facilities, and clinicians.
• Strong time management and organizational skills, with the ability to track multiple deadlines and expiring authorizations.
• Demonstrates the ability to work independently and remain self-motivated and productive without in-person supervision.
• Basic awareness of cybersecurity best practices and data privacy requirements associated with handling PHI outside of a traditional office.

REMOTE WORK REQUIREMENTS:

• Must maintain a private workspace that protects confidential information and prevents unauthorized access to protected health information (PHI).
• Must have reliable internet service sufficient to support company systems, billing applications, and video conferencing.
• Must use company-approved equipment and security measures, including VPN, multi-factor authentication, and secure storage and transmission of billing data.
• Must meet designated work schedules, performance expectations, and communication requirements, including participation in scheduled virtual meetings.

PHYSICAL REQUIREMENTS:

• Regularly uses a computer, keyboard, telephone, and other standard office equipment to perform job responsibilities.
• Must be able to perform computer-based work and communicate effectively through appropriate methods in a remote office environment.
• Work is primarily performed in a home-office setting with regular periods of computer-based activity.

MINIMUM QUALIFICATIONS:

• High School Diploma required; associate degree preferred.
• Minimum of two years of experience in prior authorization, insurance verification, medical billing, or accounts receivable; ground ambulance or EMS experience preferred.
• Experience submitting authorization requests and working denials or appeals with payers preferred.
• Previous experience working in a remote or telecommute position preferred.
• Working knowledge of electronic health record (EHR) and practice management systems, payer portals, and clearinghouse platforms.

Allegiance Mobile Health is an equal opportunity employer committed to providing a workplace free from discrimination and harassment. We consider qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other status protected by applicable federal, state, or local law. We are committed to providing reasonable accommodation to qualified individuals with disabilities throughout the employment process.