Medical Authorization Specialist

About the role

The Medical Authorization Specialist supports Enovis' Revenue Cycle Management team by securing insurance coverage for patients and ensuring accurate, timely order entry. This role collaborates with internal and external partners to obtain the documentation needed for insurance authorizations and to drive better patient outcomes.

Key responsibilities

• Answer inbound and outbound calls, research insurance information, and resolve account issues.
• Verify insurance eligibility and follow coordination of benefits guidelines.
• Determine revenue amounts based on allowable benefits, payer guidelines, and contract pricing.
• Obtain supporting documentation from the Sales Team before invoicing.
• Resolve submission issues by securing appropriate medical record documentation or validating coding.
• Challenge insurance companies on medical necessity, negotiate coverage and pricing in line with payer guidelines.
• Communicate payer trends to Management and Payor Development.
• Maintain up‑to‑date knowledge of Enovis products, competitor offerings, and clinical publications.

Required profile

• Experience with insurance eligibility verification and coordination of benefits.
• Understanding of revenue cycle concepts, including allowable amounts, copayments, and contract pricing.
• Ability to obtain and review medical record documentation for authorization purposes.
• Strong communication skills for interacting with internal teams and external payers.
• Commitment to compliance, ethics, and staying current on industry guidelines.

Required skills