Inpatient & Surgical Authorization Specialist

Rhode Island Hospital; Providence (RI); On-site; USD 30,000 - 50,000; Full time

Job summary

Brown University Health is seeking an Authorization Specialist to secure timely authorizations for inpatient and outpatient procedures. You will verify insurance coverage, document authorizations, and support revenue cycle integrity to optimize reimbursements.

In this role, you will perform financial analytics, interpret payer contracts and regulatory guidelines, and collaborate with clinical teams to resolve authorization-related issues.

Qualifications

• 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.
• Strong understanding of healthcare finance, insurance verification, and payer authorization processes.

Responsibilities

• 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.
• 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.
• 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.
• 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.
• 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.

Skills

Healthcare finance

Insurance verification

Payer authorization processes

Analytical

Communication

Independent work

Team collaboration

Epic

Cerner

Microsoft Office

Education

High school diploma or equivalent

Associate's or Bachelor's degree in healthcare administration, finance, or related field preferred

Tools

Epic

Cerner

Microsoft Office

Job description

Brown University Health is seeking an Authorization Specialist to secure timely authorizations for inpatient and outpatient procedures. You will verify insurance coverage, document authorizations, and support revenue cycle integrity to optimize reimbursements.

In this role, you will perform financial analytics, interpret payer contracts and regulatory guidelines, and collaborate with clinical teams to resolve authorization-related issues.