Insurance Verification Auth Specialist

MultiCare Health System

3d•$23 - $33•Onsite

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. This 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 key 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. This role requires the ability to interpret medical guidelines, payer policies, and benefit structures to ensure accurate financial clearance and support the efficient delivery of 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

Minimum two (2) years of experience working complex, high dollar prior-authorizations, referral coordination for relevant service lines, or in insurance billing, admitting, or registration within a healthcare setting
Customer service experience in healthcare
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 (e.g., Medical Assistant, Medical Billing & Insurance) preferred
One (1) year of post-secondary business or college coursework preferred
Certification from the National Association of Healthcare Access Management (NAHAM) preferred

Responsibilities

Secure pre-authorizations from insurance companies for a broad range of complex, high dollar healthcare services including 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 submission for ordered services.
Evaluate and process medical authorization requests efficiently to facilitate uninterrupted patient care.
Communicate effectively with healthcare providers, insurance carriers, and patients to gather and relay information necessary for authorization decisions.
Meet established daily productivity standards to maintain operational efficiency and accuracy in authorization workflows.
Perform essential registration tasks such as loading insurance details, filing orders, and verifying eligibility
Maintain a high level of accuracy to reduce the risk of insurance claim denials and ensure financial clearance for patients.
Serve as a subject matter expert on referrals, authorizations, and insurance plan guidelines within the MultiCare Health System.