Patient Access & Authorization Specialist

Beacon Health System; South Bend (IN); Hybrid; USD 38,000 - 54,000; Full time

Job summary

Beacon Health System is seeking an Insurance Verification Authorization Specialist to verify patient insurance, obtain pre-certifications, and coordinate admissions. The role requires interacting with patients, physicians, and multiple Beacon departments to ensure proper coverage and documentation.

The position emphasizes accurate data entry in Cerner, handling high call volumes, and coordinating authorizations for procedures and admissions.

Qualifications

• Requires a high school diploma or equivalent; associate degree preferred.
• Medical prior authorizations or claims experience in managed care is highly preferred.
• Excellent time management, organizational, analytical, negotiation and communication skills required.

Responsibilities

• Verify and update patient demographic and insurance information in the system.
• Obtain accurate insurance information and communicate with patient or physician office staff.
• Use Cerner to locate/retrieve scheduled patients for admission/registration input.
• Generate MSP and SurgiNet reports to verify scheduled procedures.
• Explain the need for pre-certification to maximize coverage.
• Verify and document insurance coverage via online systems or by phone.
• Validate medical necessity using the Cerner Medical Necessity Checker when applicable.
• Audit MSP questionnaires for complete fields; coordinate with Financial Counselors.
• Coordinate VOB and pre-certification with insurance providers to secure authorization.
• Ensure authorization for ancillary, surgical and outpatient testing/procedures/admissions.
• Initiate authorizations for direct admissions and emergency admissions/procedures.
• Document and release accounts once authorization is obtained and complete.
• Maintain accurate worklists and upload demographic information to payors.

Skills

Office skills

Telephone skills

Computer skills

Medical terminology

Insurance knowledge

Interpersonal skills

Time management

Education

High school diploma or equivalent

Associate's degree preferred

Tools

Cerner databases

Pathways Healthcare Scheduling

Experian

MCA Compliance Checker

Job description

Beacon Health System is seeking an Insurance Verification Authorization Specialist to verify patient insurance, obtain pre-certifications, and coordinate admissions. The role requires interacting with patients, physicians, and multiple Beacon departments to ensure proper coverage and documentation.

The position emphasizes accurate data entry in Cerner, handling high call volumes, and coordinating authorizations for procedures and admissions.