Insurance Authorization Specialist

Veterans • Worcester, MA

3d

About The Position

The Insurance Authorization Specialist is responsible for managing insurance eligibility and authorizations from admission through discharge. This includes tasks such as eligibility verification, obtaining initial authorizations, securing continued-stay extensions, processing insurance changes, tracking authorizations, following up with payers, and assisting with MassHealth and eligible managed care organization enrollment. The Specialist collaborates closely with Admissions, Clinical/Case Management, and Billing to ensure patients have appropriate insurance coverage and authorization. They are responsible for accurately maintaining authorization and insurance information in the EHR and preventing insurance or authorization-related issues from delaying admissions or payments. The role operates using an exception-management model, leveraging the EHR to track insurance eligibility, authorizations, expiration dates, insurance changes, and items requiring follow-up.

Requirements

• Experience with insurance authorizations, healthcare revenue cycle, utilization management, or related healthcare operations.
• Strong organizational, communication, and follow-up skills.
• Ability to manage multiple payer requirements and deadlines.
• Experience with EHR systems.

Nice To Haves

• Behavioral health, substance-use-disorder, CSS, RRS, BSAS, MassHealth, or Massachusetts payer experience preferred.
• AdvancedMD experience preferred.
• Knowledge of MassHealth eligibility, managed care organizations, and enrollment processes preferred.
• Certified Application Counselor (CAC) certification preferred; candidates without current certification must complete required training and certification within six months of employment.

Responsibilities

• Obtain and manage initial insurance authorizations (Notice Of Admission) for all new admissions.
• Monitor authorization expiration dates and obtain timely continued-stay extensions.
• Process authorization requirements when a patient's insurance changes.
• Communicate with insurance companies, utilization review departments, and payer portals.
• Obtain required clinical information from Clinical/Case Management for continued-stay requests.
• Maintain accurate authorization numbers, dates, units/days, and payer information in EHR.
• Monitor authorization worklists and resolve exceptions promptly.
• Identify and escalate authorization denials, reductions, or potential coverage issues.
• Work closely with Admissions to ensure authorization requirements are addressed before or at admission.
• Work closely with Billing to ensure claims have accurate authorization and insurance information.
• Maintain complete documentation of payer communications and authorization decisions.
• Help identify opportunities to improve automation, eliminate duplicate tracking, and reduce authorization-related denials.
• Verify insurance eligibility for all patients and identify and resolve coverage issues requiring follow-up.
• Assist patients with MassHealth enrollment and enrollment into an eligible managed care organization consistent with program contracting requirements.
• Assist with insurance changes, including updating coverage information and coordinating required follow-up with MassHealth or the applicable payer.

Benefits

• BCBS Medical, Dental, and Vision Insurance
• Employer Paid Short and Long-Term Disability and Life Insurance.
• $2500 Medical Opt-Out program if you have medical coverage through another source.
• Retirement Plan (403B) with a $2000 Match
• Flexible Spending Accounts
• Tuition Reimbursement Program
• Paid Parental Leave

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed