Insurance Verification & Authorization Specialist

Baystate Health; Springfield (MA); On-site; USD 27,000 - 36,000; Full time

Job summary

Baystate Health is seeking an Insurance Verification Representative to work under supervision to review and secure patient demographic and insurance information, obtain authorization details, and initiate required certifications for sponsored admissions. The role focuses on minimizing bad debt and maximizing reimbursement through accurate verification and documentation.

Key duties include verifying eligibility, obtaining benefits, following up with payers, resolving coverage issues, and

Qualifications

• Medical billing and/or Authorization and Referral focus.
• Experience with Healthcare Accounts Receivable preferred.
• Strong computer skills and knowledge of payer guidelines.

Responsibilities

• Secures accounts to obtain proper reimbursement; verifies eligibility; obtains benefits and authorizations/referrals with payer knowledge.
• Obtains certification/authorization when required and identifies coverage gaps; collaborates with providers and staff to minimize self-pay balances.
• Follows up with payers to resolve coverage/benefit issues and documents account activity thoroughly.
• Collaborates with Case Management, Denials Management, and Patient Accounting to recover payments for denials.
• Maintains knowledge of payer guidelines via web portals and carrier communications.
• Independently resolves insurance authorization and assignment issues.
• Participates in cross training to promote efficient and customer-friendly service and meet productivity standards.
• Meets all productivity standards for the position.
• Maintains account accuracy average rate of >= 97%.
• Demonstrates understanding and skilled use of necessary computer programs.

Skills

Microsoft Office Suite

Job description

Baystate Health is seeking an Insurance Verification Representative to work under supervision to review and secure patient demographic and insurance information, obtain authorization details, and initiate required certifications for sponsored admissions. The role focuses on minimizing bad debt and maximizing reimbursement through accurate verification and documentation.

Key duties include verifying eligibility, obtaining benefits, following up with payers, resolving coverage issues, and