Authorization & Eligibility Specialist Elevating Patient Care

Beth Israel Lahey Health; Beverly (MA); On-site; USD 29,000 - 39,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Financial Clearance Specialist to verify insurance eligibility, determine medical necessity, and obtain payer authorizations for outpatient services. The role supports revenue cycle by coordinating with departments and stakeholders to ensure compliant, timely access to care.

Responsibilities include reviewing eligibility, managing authorizations, and ensuring documentation accuracy while complying with policies and regulations.

Qualifications

• High School diploma or GED required.
• Associate's degree preferred.
• 1–3 years related work experience required.
• Working knowledge of CPT, HCPCS, ICD-9 and ICD-10 coding.
• Advanced skills with Microsoft Office applications (Outlook, Word, Excel, PowerPoint, Access).
• Knowledge of Craneware software (preferred).
• Knowledge of payer policies for medical necessity/authorization requirements (preferred).

Responsibilities

• Verify patient insurance eligibility for visits using online tools and by contacting the payer.
• Determine medical necessity determinations before services are rendered and inform departments.
• Identify authorization requirements and obtain payer authorization when needed.
• Escalate issues to revenue cycle peers and coordinate with leadership and clinical stakeholders.
• Complete assigned work queues and report daily to maintain productivity and quality.
• Ensure compliance with BIDMC policies and federal/state requirements.
• Generate periodic reports on operational, productivity, and quality metrics.
• Assist with urgent or walk-in visits; refer complex issues to financial counselors.

Skills

Customer service

Problem solving

Oral communications

Written communications

Teamwork

Education

High School diploma or GED required

Associate's degree preferred

Tools

Outlook

Word

Excel

PowerPoint

Access

Craneware

Job description

Beth Israel Lahey Health is seeking a Financial Clearance Specialist to verify insurance eligibility, determine medical necessity, and obtain payer authorizations for outpatient services. The role supports revenue cycle by coordinating with departments and stakeholders to ensure compliant, timely access to care.

Responsibilities include reviewing eligibility, managing authorizations, and ensuring documentation accuracy while complying with policies and regulations.