BrightSpan Health is seeking a Authorization & Benefits Specialist to support patient access and revenue cycle operations by verifying insurance benefits, securing prior authorizations, and ensuring compliance with payer guidelines. This role plays a critical part in facilitating timely care delivery and accurate claims processing by coordinating with insurance payers, clinical teams, and internal departments.
What You’ll Do:
- Verify patient insurance coverage, eligibility, and benefits by contacting insurance payers directly.
- Secure prior authorizations and pre-certifications for medical procedures, diagnostics, treatments, and services.
- Identify and document authorization or referral requirements and communicate them to relevant internal teams.
- Accurately enter and maintain insurance and authorization data in electronic health records (EHR) or practice management systems.
- Monitor and track insurance changes, payer updates, and benefit policy revisions, ensuring timely communication to stakeholders.
- Resolve discrepancies in insurance information by coordinating with patients, payers, and internal teams.
- Maintain organized documentation of all authorization and benefits verification activities in compliance with HIPAA and organizational standards.
- Collaborate with clinical, billing, and administrative staff to align authorizations with scheduled services and claims processing.
- Support departmental goals and assist with special projects or additional duties as assigned.
What You’ll Need:
- High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration or related field preferred.
- 2+ years of experience in insurance verification, prior authorization, or related healthcare administrative work.
- Thorough knowledge of insurance plans, payer authorization requirements, and medical terminology.
- Familiarity with commercial, Medicaid, and Medicare benefit structures.
- Proficiency in EHR systems, payer portals, and Microsoft Office.
- Strong attention to detail, organizational skills, and ability to manage multiple tasks in a fast-paced environment.
- Excellent communication and interpersonal skills for professional interaction with payers, patients, and internal teams.
- Knowledge of HIPAA regulations and patient privacy standards.
Preferred Qualifications:
- Experience with CPT, ICD-10, and HCPCS coding.
- Bilingual abilities (especially Spanish).
- Experience in specialty or multi-site healthcare settings.
Why BrightSpan?
- Competitive compensation among industry peers
- Medical, dental, and vision insurance
- FSA & HSA plans available
- Paid time off and holidays
- Opportunities for professional and career development in a growing organization