SUMMARY:

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

span style=font-weight: 800Authorization & VerificationFinancial Analytics & Revenue OptimizationPatient Interaction & CollectionsDenial Prevention & Bad Debt ReductionDocumentation & Complianceh3/h3

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.h3/h3
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.h3/h3
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.h3/h3
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.h3/h3
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

Education & ExperienceSkills & Competenciesh3/h3

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.h3/h3
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.

Pay Range:

$22.04

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Corporate Headquarters

15 LaSalle Square Providence, Rhode Island 02903

Work Type:

8:00am-4:30pm

Work Shift:

Day Daily Hours:

8 hours

Driving Required:

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