Prior Authorization Specialist, Verification of Benefits, Full-time Days

Beacon Health System; Granger (IN); On-site; USD 42,000 - 58,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

403(b) Matching

PTO

Shift Differentials

EAP

Tuition Reimbursement

Clinical Ladder

Gym Discount

Job summary

Beacon Health System is seeking a full-time day shift Prior Authorization Specialist for VERIFICATION OF BENEFITS in Granger, IN. You will evaluate referred services to determine authorization requirements, review clinical documentation, and support reimbursement while delivering compassionate customer service.

Applicants should have relevant education or experience, knowledge of ICD-10/CPT, and proficiency with Microsoft Office.

Qualifications

• Associate’s degree in Business, Healthcare, or related field; or 3 years medical authorization or related experience with high school diploma.
• Experience with ICD-10, CPT, and prior authorization processes is required.
• Strong communication and customer service skills with attention to detail.

Responsibilities

• Serve as the primary contact for designated prior authorization needs.
• Collect and review clinical documentation to support authorization qualification.
• Evaluate orders for insurance coverage and authorization requirements.
• Ensure testing and carrier requirements are met within guidelines and timeframes.
• Assist with appeals and coordinate with providers and authorization agents.

Skills

Medical terminology

ICD-10/CPT

Communication

Payor guidelines

Education

Associate’s degree in Business, Healthcare, or related field

High school diploma + 3 years experience

Tools

Microsoft Office (Outlook, Excel, Word)

Job description

Beacon Health System is hiring a full-time day shift Prior Authorization Specialist position for our Verification of Benefits at Beacon Health System in Granger, IN.

Be a Beacon. Make a Difference.

We offer a wide variety of benefits for our employees, including:

• Medical, Dental, & Vision Insurance through Cigna
• Life Insurance
• 403(b) Matching Retirement Fund
• Competitive Paid Time Off (PTO)
• Shift Differentials
• Employee Assistance Program (EAP)
• Tuition and Certification Reimbursement
• Clinical Ladder Program
• Local and National Discounts
• Beacon Academy Educational Courses
• Gym Membership Discount

About Beacon Health System

Headquartered in South Bend, Indiana, as a not-for-profit, community-governed health system, Beacon Health System provides care to more than 4,000 patients each day in northern Indiana and southern Michigan.

What You’ll Do

As a Prior Authorization Specialist, you'll evaluate designated referred services to determine authorization requirements based on government and commercial payor guidelines. You'll obtain, review, and disseminate clinical and coding documentation necessary to support the authorization process and ensure appropriate reimbursement. In addition, you'll provide exceptional customer service during every interaction with patients, families, visitors, and Beacon Medical Group associates by communicating with empathy, professionalism, and clarity regarding authorization requirements and the next steps in the patient's care journey.

Prior Authorization Specialist – Job Responsibilities

• Serve as the primary contact and resource for all designated prior authorization needs.
• Identify, collect, and coordinate clinical documentation to support qualification for ordered services.
• Evaluate orders for insurance coverage and authorization requirements.
• Ensure carrier process requirements are met within contracted guidelines and established timeframes.
• Ensure appropriate testing is completed.
• Utilize tools in accordance with provider preferences, testing criteria, insurance requirements, modality-specific ordering guidelines, and authorization guidelines.
• Review and respond to additional information requests.
• Validate completed authorizations to ensure they correspond with the ordered service, code, timeframe, and provider.
• Support the appeals process by communicating and coordinating resolution expectations with providers and authorization agents.
• Maintain standardized records to support effective coordination, tracking, and reporting of departmental activities and metrics.
• Advocate for patients by recognizing when to challenge unfavorable prior authorization determinations.
• Negotiate and dispute authorization decisions, when necessary, on behalf of Beacon Health System and the patient to achieve a positive outcome.
• Provide exceptional, customer-centered service during every interaction with patients, families, and associates.
• Use critical thinking skills to make decisions, identify problems, develop solutions, and assist with implementing changes. Escalate concerns when appropriate.
• Participate in performance improvement initiatives by following established work systems, identifying deviations or deficiencies in standards, systems, or processes, and communicating concerns to leadership.
• Prioritize work effectively to meet deadlines and service expectations.
• Work in a fast-paced environment while maintaining accuracy and attention to detail.
• Understand the workflow and rhythm of each task to support convenient, connected, and coordinated patient care.
• Use multiple software platforms, including electronic medical records (EMRs), insurance portals, referral databases, and scheduling systems, to support patient care activities.

What You Bring

As a Prior Authorization Specialist, you'll bring strong communication and analytical skills to effectively collaborate with patients, providers, insurance carriers, and interdisciplinary teams. You demonstrate the ability to clearly communicate complex information, interpret and evaluate clinical and insurance-related data, and navigate prior authorization requirements with accuracy and professionalism. You maintain confidentiality when handling sensitive patient information and remain composed and professional in challenging situations. Your knowledge of medical procedures, CPT and ICD-10 coding, insurance guidelines, and payor requirements allows you to effectively coordinate and manage the authorization process. You possess strong customer service, organizational, and problem-solving skills, along with proficiency in Microsoft Office applications, to support efficient operations and positive patient outcomes. You stay current on insurance regulations and industry updates and use your expertise to resolve denials, support appeals, and ensure compliance with payer requirements.

Required Qualifications

• Associate’s degree in Business, Healthcare, or a related field and one year of medical authorization-related experience; or a high school diploma/equivalent and three years of medical authorization or related experience.
• Successful completion of an approved Medical Assistant Program and certification exam, or equivalent medical office experience, preferred.
• Experience with medical terminology, ICD-10, CPT, prior authorizations, third-party payors, and prior authorization processes required.
• Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.