Beacon Health System is hiring a full-time day shift Prior Authorization Specialist position for our Verification of Benefits at Beacon Health System in Granger, IN.
Be a Beacon. Make a Difference.
At Beacon Health System, you’re not just part of a team, you’re part of something bigger. Every patient interaction is a chance to lead with compassion, build trust, and create lasting impact. Here, your expertise supports healing, and your heart connects us to the communities we serve.
We offer a wide variety of benefits for our employees, including:
- Medical, Dental, & Vision Insurance through Cigna
- Life Insurance
- 403(b) Matching Retirement Fund
- Competitive Paid Time Off (PTO)
- Shift Differentials
- Employee Assistance Program (EAP)
- Tuition and Certification Reimbursement
- Clinical Ladder Program
- Local and National Discounts
- Beacon Academy Educational Courses
- Gym Membership Discount
About Beacon Health System
Headquartered in South Bend, Indiana, as a not-for-profit, community-governed health system, Beacon Health System provides care to more than 4,000 patients each day in northern Indiana and southern Michigan.
What You’ll Do
As a Prior Authorization Specialist, you'll evaluate designated referred services to determine authorization requirements based on government and commercial payor guidelines. You'll obtain, review, and disseminate clinical and coding documentation necessary to support the authorization process and ensure appropriate reimbursement. In addition, you'll provide exceptional customer service during every interaction with patients, families, visitors, and Beacon Medical Group associates by communicating with empathy, professionalism, and clarity regarding authorization requirements and the next steps in the patient's care journey.
Prior Authorization Specialist – Job Responsibilities
- Serve as the primary contact and resource for all designated prior authorization needs.
- Identify, collect, and coordinate clinical documentation to support qualification for ordered services.
- Evaluate orders for insurance coverage and authorization requirements.
- Ensure carrier process requirements are met within contracted guidelines and established timeframes.
- Ensure appropriate testing is completed.
- Utilize tools in accordance with provider preferences, testing criteria, insurance requirements, modality-specific ordering guidelines, and authorization guidelines.
- Review and respond to additional information requests.
- Validate completed authorizations to ensure they correspond with the ordered service, code, timeframe, and provider.
- Support the appeals process by communicating and coordinating resolution expectations with providers and authorization agents.
- Maintain standardized records to support effective coordination, tracking, and reporting of departmental activities and metrics.
- Advocate for patients by recognizing when to challenge unfavorable prior authorization determinations.
- Negotiate and dispute authorization decisions, when necessary, on behalf of Beacon Health System and the patient to achieve a positive outcome.
- Provide exceptional, customer-centered service during every interaction with patients, families, and associates.
- Use critical thinking skills to make decisions, identify problems, develop solutions, and assist with implementing changes. Escalate concerns when appropriate.
- Participate in performance improvement initiatives by following established work systems, identifying deviations or deficiencies in standards, systems, or processes, and communicating concerns to leadership.
- Prioritize work effectively to meet deadlines and service expectations.
- Work in a fast-paced environment while maintaining accuracy and attention to detail.
- Understand the workflow and rhythm of each task to support convenient, connected, and coordinated patient care.
- Use multiple software platforms, including electronic medical records (EMRs), insurance portals, referral databases, and scheduling systems, to support patient care activities.
What You Bring
As a Prior Authorization Specialist, you'll bring strong communication and analytical skills to effectively collaborate with patients, providers, insurance carriers, and interdisciplinary teams. You demonstrate the ability to clearly communicate complex information, interpret and evaluate clinical and insurance-related data, and navigate prior authorization requirements with accuracy and professionalism. You maintain confidentiality when handling sensitive patient information and remain composed and professional in challenging situations. Your knowledge of medical procedures, CPT and ICD-10 coding, insurance guidelines, and payor requirements allows you to effectively coordinate and manage the authorization process. You possess strong customer service, organizational, and problem-solving skills, along with proficiency in Microsoft Office applications, to support efficient operations and positive patient outcomes. You stay current on insurance regulations and industry updates and use your expertise to resolve denials, support appeals, and ensure compliance with payer requirements.
Required Qualifications
- Associate’s degree in Business, Healthcare, or a related field and one year of medical authorization-related experience; or a high school diploma/equivalent and three years of medical authorization or related experience.
- Successful completion of an approved Medical Assistant Program and certification exam, or equivalent medical office experience, preferred.
- Experience with medical terminology, ICD-10, CPT, prior authorizations, third-party payors, and prior authorization processes required.
- Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.
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