Healthcare Prior Authorization Pro

Beth Israel Lahey Health; Beverly (MA); Vor Ort; USD 28.000 - 38.000; Vollzeit

Zusammenfassung

Beth Israel Lahey Health is seeking a Healthcare Financial Clearance Specialist to complete all financial clearance activities for outpatient services. You will verify insurance eligibility, determine medical necessity, and obtain authorizations as required, ensuring compliance and smooth patient flow.

In this role you will collaborate with departments and revenue cycle teams, provide feedback on payer requirements, and support urgent or walk-in visits while maintaining high accuracy and service

Qualifikationen

• High School diploma or GED required; Associate's degree preferred.
• 1-3 years related work experience.
• Knowledge of CPT, HCPCS, and ICD-9/ICD-10 coding.
• Advanced skills with Microsoft applications (Outlook, Word, Excel, PowerPoint or Access) and other web-based apps.

Aufgaben

• Verifies patient's insurance eligibility for visit using online tools or payer contact (essential).
• Determines medical necessity before services and informs departments of outcomes (essential).
• Obtains payer authorization per protocol and coordinates any additional information needed (essential).
• Escalates issues and coordinates with revenue cycle peers and stakeholders; documents results.
• Completes work queues and reports daily to meet productivity and quality standards; assists with urgent/walk-in visits.
• Ensures compliance with policies; identifies trends and reports on metrics.

Kenntnisse

CPT coding

HCPCS coding

ICD coding

Microsoft Office

Ausbildung

High School diploma or GED

Associate degree preferred

Tools

Craneware

Jobbeschreibung

Beth Israel Lahey Health is seeking a Healthcare Financial Clearance Specialist to complete all financial clearance activities for outpatient services. You will verify insurance eligibility, determine medical necessity, and obtain authorizations as required, ensuring compliance and smooth patient flow.

In this role you will collaborate with departments and revenue cycle teams, provide feedback on payer requirements, and support urgent or walk-in visits while maintaining high accuracy and service