Insurance Verification Auth Specialist Special Srvc
About The Position
The Insurance Verification Auth Specialist is responsible for securing financial clearance and completing pre-authorization for patients undergoing complex, high-dollar inpatient and outpatient surgical procedures, hematology/oncology treatments, and infusion services. The role includes verifying insurance eligibility and benefits, validating referrals and prior authorizations, and submitting and monitoring authorization requests in accordance with MultiCare Health System’s productivity and quality standards. The Specialist serves as a resource on insurance plan guidelines and authorization processes, collaborates with referring providers to resolve pre-service authorization denials, and communicates Advance Beneficiary Notice (ABN) requirements when applicable. The position requires interpreting medical guidelines, payer policies, and benefit structures to ensure accurate financial clearance and support access to specialized healthcare services. The Specialist also acts as a functional expert across Patient Access and clinical teams, contributing to best practices in financial coordination and patient care access.
Requirements
- At least two years of experience with complex, high-dollar prior authorizations; referral coordination for relevant service lines; or insurance billing, admitting, or registration in a healthcare setting.
- Healthcare customer service experience.
- Proficiency in medical terminology, validated by examination.
- Experience reviewing medical policies and interpreting CPT and HCPCS codes in alignment with payer guidelines.
Nice To Haves
- Completion of a health vocational program, such as Medical Assistant or Medical Billing & Insurance.
- One year of post-secondary business or college coursework.
- Certification from the National Association of Healthcare Access Management (NAHAM).
Responsibilities
- Secure pre-authorizations from insurance companies for complex, high-dollar inpatient and outpatient surgical procedures, hematology/oncology treatments, and infusion services.
- Respond to clinical inquiries through insurance portals to support timely authorization approvals.
- Review medical records and supporting documentation to ensure complete and accurate submissions for ordered services.
- Evaluate and process medical authorization requests efficiently to facilitate uninterrupted patient care.
- Communicate with healthcare providers, insurance carriers, and patients to gather and relay information needed for authorization decisions.
- Meet established daily productivity standards while maintaining efficiency and accuracy in authorization workflows.
- Perform essential registration tasks, including loading insurance details, filing orders, and verifying eligibility.
- Maintain accuracy to reduce the risk of insurance claim denials and ensure patients’ financial clearance.
- Serve as a subject matter expert on referrals, authorizations, and insurance plan guidelines within MultiCare Health System.
Benefits
- Competitive tuition assistance, residencies, fellowships, and career development.
- Generous paid time off.
- Code Lavender and Employee Assistance Programs.
- Medical, dental, and retirement benefits.
- Paid time off.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
