Insurance Authorization & Advocacy Specialist

Job Description

Job Description

Position Summary

The GAP Advocate is responsible for managing Out of Network authorizations for clients. This role manages authorizations from initiation through final determination, ensuring timely submission, strategic planning, accurate documentation, and proactive communication with providers, patients, and insurance companies.

Key Responsibilities

• Monitor new cases and assess GAP eligibility based on insurance coverage.
• Manage GAP cases through all processing stages until final determination.
• Review insurance policies to identify coverage gaps and strategize for approvals and overturning denials.
• Prepare and finalize GAP letters with accurate coding, complete documentation, and strong justification.
• Communicate with patients, providers, and insurers to gather information and secure GAP authorization.
• Maintain workflow efficiency and delegate tasks to remote team members as needed.
• Provide timely updates and weekly case status reports to supervisors and practices.

Required Skills & Competencies

• Problem Solving: Resourceful, able to identify issues and troubleshoot effectively.
• Management & Organization: Strong organizational skills; able to prioritize, handle multiple tasks and maintain smooth workflows.
• Communication: Professional and respectful communication with internal teams and external contacts.
• Critical Thinking: Quick thinker with sound judgment and common sense.
• Self-Motivated & Driven: Works independently, takes initiative, and demonstrates a desire to learn.

Tools & Systems

• Portals: Salesforce, Quickbase Reports, Power BI
• Communication: Microsoft Teams, Email, Phone
• Collaboration: Remote team members, Supervisors, Upper Management, Coders, IT, Clients, Insurance, INN doctors, Patients

Benefits

M&D Capital offers our employees a comprehensive benefits package, including health, dental, vision, employee assistance plan, paid family leave, short-term disability and life insurance. We also provide a 401(k) plan with employer match, flexible spending accounts, employee discount program and an employee referral program.

Salary

This position offers a salary range of $45,000 to $65,000 annually, commensurate with experience.