Revenue Cycle Navigator: Medical Authorization & Eligibility

Beth Israel Lahey Health; United States; On-site; USD 29,000 - 39,000; Full time

Job summary

Beth Israel Lahey Health, Inc. in the United States seeks a Financial Clearance Associate to complete all financial clearance activities for outpatient services, ensuring medical necessity and authorization requirements are met.

You will verify insurance eligibility, determine authorization needs, escalate issues, and coordinate with departments and revenue cycle peers. The role supports financial counselors and adheres to policies.

Qualifications

• High School diploma or GED required; Associate's degree preferred.
• 1-3 years related work experience required.
• Working knowledge of CPT, HCPCS coding and ICD-9/10.
• Advanced skills with Microsoft Office applications.

Responsibilities

• Verifies patient's insurance eligibility for visit using online tools or payer contact.
• Identifies payer medical necessity determination before services are rendered.
• Determines authorization requirement and obtains payer authorization when needed.
• Identifies and escalates issues and coordinates with leadership and stakeholders.
• Completes work queues and assists with reviewing medical necessity and authorizations.
• Follows BIDMC policies to ensure compliance with requirements.
• Identifies trends and provides periodic operational reports.
• Performs other activities to support the department.

Skills

CPT/HCPCS/ICD coding

Microsoft Office

1-3 years experience

Education

High School diploma or GED

Associate's degree preferred

Tools

Craneware

Job description

Beth Israel Lahey Health, Inc. in the United States seeks a Financial Clearance Associate to complete all financial clearance activities for outpatient services, ensuring medical necessity and authorization requirements are met.

You will verify insurance eligibility, determine authorization needs, escalate issues, and coordinate with departments and revenue cycle peers. The role supports financial counselors and adheres to policies.