BPN Insurance Verification and Authorization Specialist

GENERAL SUMMARY:

Verifies patient insurance coverage and benefits and obtains required prior authorizations to ensure services are financially cleared before care is delivered. Coordinates with payers, provider offices, and internal teams to collect documentation, submit authorization requests, and meet established turnaround requirements. Communicates authorization outcomes, financial responsibility, and coverage limitations to patients and stakeholders. Supports revenue integrity and patient access through accurate documentation and timely follow‑up.

PRINCIPAL JOB FUNCTIONS

• *Commits to the mission, vision, beliefs and consistently demonstrates our core values.
• *Verifies insurance eligibility and benefits for scheduled services, admissions, referrals, and medications.
• *Obtains required pre‑certifications, referrals, and prior authorizations in accordance with payer guidelines.
• *Collects and submits clinical documentation and supporting information to payers using phone, fax, and web-based portals, and/or Real Time Authorization (RTA) platforms.
• *Documents authorization activity, approval details, dates, and payer communications in designated systems.
• *Communicates authorization status, non‑coverage notices, and next steps to patients and ordering offices.
• *Coordinates with revenue cycle, billing, and utilization management teams to support claim readiness.
• *Provides service estimates or connects patients to financial estimate resources as appropriate.
• *Prioritizes urgent and emergent cases to meet defined turnaround expectations.
• *Supports patient access workflows and performs additional department functions as assigned.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Participates in meetings, committees and department projects as assigned.
• Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. Experience in healthcare patient access, insurance verification, billing, or related administrative support.