Inpatient Authorization Specialist-2

Authorization Specialist

The Authorization Specialist is responsible for securing timely and accurate insurance authorizations for both inpatient admissions (elective, urgent/emergent) and outpatient surgical day care procedures. This role ensures compliance with payer requirements, supports revenue cycle integrity, and plays a critical part in optimizing financial outcomes by combining healthcare finance knowledge with strong analytical and communication skills. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate.

Responsibilities:

- Obtain and document prior authorizations for inpatient admissions and outpatient surgical procedures from commercial and government payers.

- Verify patient insurance coverage and eligibility prior to scheduled procedures and admissions.

- Ensure all authorizations are in place to avoid delays or cancellations.

- Complete notification of admission for inpatient admissions.

- Conduct financial analytics to determine a patient's estimated financial responsibility across the healthcare system.

- Interpret payer contracts and state/federal regulatory guidelines to ensure accurate reimbursement and maximize revenue realization.

- Collaborate with revenue cycle and clinical teams to identify and resolve authorization-related issues that may impact reimbursement.

- Communicate with patients regarding their financial obligations, including co-pays, deductibles, and out-of-pocket costs.

- Secure upfront payments or establish payment arrangements prior to the date of service.

- Provide clear and empathetic financial counseling to patients, ensuring understanding and satisfaction.

- Minimize claim denials by ensuring all authorization and documentation requirements are met.

- Work proactively to reduce bad debt through timely patient collections and accurate financial clearance.

- Monitor and report trends in denials and collaborate with internal teams to implement corrective actions.

- Maintain accurate and up-to-date records of all authorization activities in the electronic health record (Epic) and patient accounting systems.

- Ensure compliance with HIPAA, payer guidelines, and internal policies.

- Participate in audits and quality improvement initiatives as needed.

Minimum Qualifications:

- High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, finance, or related field preferred.

- Minimum 2 years of experience in medical authorization, patient access, or revenue cycle operations, preferably in a surgical or ambulatory care setting.

- Strong understanding of healthcare finance, insurance verification, and payer authorization processes.

- Proficiency in interpreting payer contracts and regulatory guidelines.

- Excellent analytical, problem-solving, and communication skills.

- Ability to work independently and collaboratively in a fast-paced environment.

- Experience with EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite.