Pre-Authorization & Insurance Verification Specialist

Bryan College Of Health Sciences; Lincoln (NE); Hybrid; USD 32,000 - 45,000; Full time

Job summary

Bryan Health in Lincoln, NE is seeking an Authorization Specialist to review procedures, referrals and medications against payer guidelines before services are rendered to maximize reimbursement.

The role focuses on coordinating pre-service authorizations, communicating with physician offices and patients, and ensuring accurate documentation of all authorization activities across systems, while maintaining confidentiality and compliance.

Qualifications

• High School diploma and one (1) year relevant work experience in a medical clinic, health care, insurance industry, pharmacy or medical billing office required.

Responsibilities

• 1. Commits to the mission, vision, beliefs of Bryan Health and consistently demonstrates our core values.
• 2. Serves as work resource and liaison to hospital departments, physician offices and patients for pre-service authorization.
• 3. Adheres to federal regulations regarding Advance Directives, COBRA, Medicare, Corporate Compliance, Joint Commission, OSHA and HIPAA; reports safety and customer concerns.
• 4. Maintains productivity and quality standards as defined through the organizational and departmental goals and objectives.
• 5. Serves as work resource and liaison to internal and external hospital departments, physicians’ offices and patients for pre-service authorizations.
• 6. Submits patients supporting medical records and necessary information to payer authorization representatives for prior authorizations via fax, phone or online portals.
• 7. Submits prior-authorization request for prescription medications using online portals, fax or phone along with supporting medical records.
• 8. Accurately and completely documents all actions taken regarding the prior authorization process including the authorization numbers, authorized dates and all other applicable information in the applicable computer systems
• 9. Ensures that pre-certification and/or authorization and referral requirements have been completed by placing phone calls to insurance companies, physician offices, patients, and utilizing web based applications and/or internet resources; obtains clinical information from physician offices and/or Bryan system; contacts BPN coding staff to obtain CPT and/or ICD-9 codes.
• 10. Explains notice of non-coverage or offers to re-schedule elective tests and procedures when patient’s pre-authorization is not obtained; notifies patient and physician of outcome; Provides effective communication, proactively and in response, to patients/family members, team members, physicians and other healthcare providers while maintaining confidentiality.
• 11. Coordinates obtaining waiver of liability when third party payers deny coverage or services that are non-covered.
• 12. Prepares and provides patients with an estimate, if one is warranted, for their expected services and/or connect the patient/guarantor to the estimates team.
• 13. Maintains accurate payer website information and logins to ensure most current information is obtained for the necessary authorization requirements.
• 14. Communicates with Patient Financial Services regarding denials and appeals/reconsideration letters received from payers.
• 15. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• 16. Participates in meetings, committees and department projects as assigned.
• 17. Performs other related projects and duties as assigned.

Education

High School diploma

Certified Medical Assistant or Medication Aide (preferred)

Job description

Bryan Health in Lincoln, NE is seeking an Authorization Specialist to review procedures, referrals and medications against payer guidelines before services are rendered to maximize reimbursement.

The role focuses on coordinating pre-service authorizations, communicating with physician offices and patients, and ensuring accurate documentation of all authorization activities across systems, while maintaining confidentiality and compliance.