Inpatient Authorization Specialist-2

Brown University Health; Providence (RI); On-site; USD 30,000 - 50,000; Full time

Job summary

Brown University Health is seeking an Authorization Specialist to secure timely prior authorizations for inpatient and outpatient procedures, verify coverage, and document all authorizations in Epic. You will analyze payer contracts to support accurate reimbursement, collaborate with revenue cycle and clinical teams, and provide clear financial counseling to patients while ensuring HIPAA compliance.

The role requires strong communication, attention to detail, and the ability to work in a

Qualifications

• High school diploma or equivalent; Associate’s or Bachelor’s preferred.
• Minimum 2 years in medical authorization, patient access, or revenue cycle operations, preferably in surgical/ambulatory care.

Responsibilities

• Authorization & verification: obtain and document prior authorizations for inpatient and outpatient procedures; verify coverage and eligibility; ensure authorizations are in place to avoid delays; notify admission for inpatient cases.

Skills

Healthcare finance

Insurance verification

Payer authorization

Contract interpretation

Analytical skills

Communication skills

EHR systems (Epic Cerner)

MS Office

Education

High school diploma or equivalent

Associate's or Bachelor's in healthcare administration/finance or related field

Job description

SUMMARY: The Authorization Specialist is responsible for securing timely and accurate insurance authorizations for both inpatient admissions (elective, urgent/emergent) and outpatient surgical day care procedures. This role ensures compliance with payer requirements, supports revenue cycle integrity, and plays a critical part in optimizing financial outcomes by combining healthcare finance knowledge with strong analytical and communication skills. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate

RESPONSIBILITIES:

• Authorization & Verification
  • Obtain and document prior authorizations for inpatient admissions and outpatient surgical procedures from commercial and government payers.
  • Verify patient insurance coverage and eligibility prior to scheduled procedures and admissions.
  • Ensure all authorizations are in place to avoid delays or cancellations.
  • Complete notification of admission for inpatient admissions.
• Financial Analytics & Revenue Optimization
  • Conduct financial analytics to determine a patient’s estimated financial responsibility across the healthcare system.
  • Interpret payer contracts and state/federal regulatory guidelines to ensure accurate reimbursement and maximize revenue realization.
  • Collaborate with revenue cycle and clinical teams to identify and resolve authorization-related issues that may impact reimbursement.
• Patient Interaction & Collections
  • Communicate with patients regarding their financial obligations, including co-pays, deductibles, and out-of-pocket costs.
  • Secure upfront payments or establish payment arrangements prior to the date of service.
  • Provide clear and empathetic financial counseling to patients, ensuring understanding and satisfaction.
• Denial Prevention & Bad Debt Reduction
  • Minimize claim denials by ensuring all authorization and documentation requirements are met.
  • Work proactively to reduce bad debt through timely patient collections and accurate financial clearance.
  • Monitor and report trends in denials and collaborate with internal teams to implement corrective actions.
• Documentation & Compliance
  • Maintain accurate and up-to-date records of all authorization activities in the electronic health record (Epic) and patient accounting systems.
  • Ensure compliance with HIPAA, payer guidelines, and internal policies.
  • Participate in audits and quality improvement initiatives as needed.

MINIMUM QUALIFICATIONS:

• Education & Experience
  • High school diploma or equivalent required; Associate’s or Bachelor’s degree in healthcare administration, finance, or related field preferred.
  • Minimum 2 years of experience in medical authorization, patient access, or revenue cycle operations, preferably in a surgical or ambulatory care setting.
• Skills & Competencies
  • Strong understanding of healthcare finance, insurance verification, and payer authorization processes.
  • Proficiency in interpreting payer contracts and regulatory guidelines.
  • Excellent analytical, problem-solving, and communication skills.
  • Ability to work independently and collaboratively in a fast-paced environment.
  • Experience with EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite.

Pay Range: $22.04-$36.37

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type: 8:00am-4:30pm

Work Shift: Day

Daily Hours: 8 hours

Driving Required: Yes