Insurance Authorization Specialist

The Insurance Authorization Specialist is responsible for managing insurance eligibility and authorizations from admission through discharge, including eligibility verification, initial authorizations, continued-stay extensions, insurance changes, authorization tracking and payer follow-up, and assistance with MassHealth and eligible managed care organization enrollment.

The Specialist works closely with Admissions, Clinical/Case Management, and Billing to ensure that patients have the appropriate insurance coverage and authorization, authorization information and insurance information is accurately maintained in EHR, and insurance or authorization-related issues do not delay admissions or payment.

The position operates primarily through an exception-management model, using EHR to track insurance eligibility, authorizations, expiration dates, insurance changes and items requiring follow-up.

Responsibilities

• Obtain and manage initial insurance authorizations (Notice Of Admission) for all new admissions.
• Monitor authorization expiration dates and obtain timely continued-stay extensions.
• Process authorization requirements when a patient's insurance changes.
• Communicate with insurance companies, utilization review departments, and payer portals.
• Obtain required clinical information from Clinical/Case Management for continued-stay requests.
• Maintain accurate authorization numbers, dates, units/days, and payer information in EHR.
• Monitor authorization worklists and resolve exceptions promptly.
• Identify and escalate authorization denials, reductions, or potential coverage issues.
• Work closely with Admissions to ensure authorization requirements are addressed before or at admission.
• Work closely with Billing to ensure claims have accurate authorization and insurance information.
• Maintain complete documentation of payer communications and authorization decisions.
• Help identify opportunities to improve automation, eliminate duplicate tracking, and reduce authorization-related denials.
• Verify insurance eligibility for all patients and identify and resolve coverage issues requiring follow-up.
• Assist patients with MassHealth enrollment and enrollment into an eligible managed care organization consistent with program contracting requirements.
• Assist with insurance changes, including updating coverage information and coordinating required follow-up with MassHealth or the applicable payer.

Qualifications

• Experience with insurance authorizations, healthcare revenue cycle, utilization management, or related healthcare operations.
• Behavioral health, substance-use-disorder, CSS, RRS, BSAS, MassHealth, or Massachusetts payer experience preferred.
• Strong organizational, communication, and follow-up skills.
• Ability to manage multiple payer requirements and deadlines.
• Experience with EHR systems; AdvancedMD experience preferred.
• Knowledge of MassHealth eligibility, managed care organizations, and enrollment processes preferred.
• Certified Application Counselor (CAC) certification preferred; candidates without current certification must complete required training and certification within six months of employment.

WHAT WE CAN OFFER YOU:

Comprehensive Benefits Package for FT employees includes:

• BCBS Medical, Dental, and Vision Insurance
• Employer Paid Short and Long-Term Disability and Life Insurance.
• $2500 Medical Opt-Out program if you have medical coverage through another source.
• Retirement Plan (403B) with a $3000 Match
• Flexible Spending Accounts
• Tuition Reimbursement Program
• Paid Parental Leave

For more information, or to apply now; visit our website. Please do not mail, email, or fax your cover letter/resume as we are limited to only accepting completed applications through our career page. Mailed, emailed, or faxed cover letter, resume, and applications will not be reviewed.

Veterans Inc. is proud to be an equal opportunity employer. We are committed to equal employment opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, marital status, disability, gender identity or protected Veteran status. If you need assistance completing an application please contact [email protected].

We do not accept unsolicited resumes from agencies. Agencies are requested not to contact Veterans Inc. with recruiting inquiries.