Strategic Insurance Verification & Authorization Specialist

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

Job summary

Baystate Health is seeking an Insurance Verification Representative in Springfield, MA, to review, verify, and secure patient demographic and insurance information, obtain authorizations, and initiate required certifications for sponsored admissions.

The role involves minimizing bad debt, maximizing reimbursement, and collaborating across Care Management, Financial Counselors, and Patient Accounting to resolve denials and ensure accurate documentation.

Qualifications

• Medical billing and/or Authorization and Referral focus.
• Healthcare Accounts Receivable experience is preferred.

Responsibilities

• Verify eligibility and obtain authorizations/referrals for payers.
• Identify coverage gaps and coordinate with providers and departments to minimize self-pay balances.
• Follow up with payers to resolve coverage issues and document activity.
• Collaborate with Case Management, Denials Management, and Patient Accounting to recover payment for denials.
• Maintain knowledge of payer guidelines and use web portals and carrier communications.
• Resolve insurance authorization and assignment issues independently.
• Participate in cross training to provide efficient, customer-friendly service.
• Meet productivity standards and maintain high account accuracy (≥97%).
• Demonstrate proficient use of necessary computer programs.

Skills

Microsoft Office Suite Skills

Job description

Baystate Health is seeking an Insurance Verification Representative in Springfield, MA, to review, verify, and secure patient demographic and insurance information, obtain authorizations, and initiate required certifications for sponsored admissions.

The role involves minimizing bad debt, maximizing reimbursement, and collaborating across Care Management, Financial Counselors, and Patient Accounting to resolve denials and ensure accurate documentation.