Job Description
Why BrightSpan?- At BrightSpan Health, our mission is to bridge the gap between clinical care and operational clarity—empowering providers through expert revenue cycle solutions that ease administrative burdens, restore peace of mind, and make room for what matters most: their clients. We’re not just managing claims—we’re shaping futures for providers, their patients and the communities they serve.
- We envision a healthcare system where providers are free to lead with compassion, where financial clarity supports clinical excellence, and where every provider organization has the tools to thrive—behind the scenes and beyond. BrightSpan exists to illuminate the path forward, one bridge at a time.
Department: Care Access
Reports To: Manager of Care Access
FLSA Status: Exempt
Location: Hybrid or Fully Remote
BrightSpan Health is seeking an
Authorization Specialist . This role is responsible for obtaining and managing prior authorizations and pre-certifications by verifying insurance benefits, submitting accurate requests, and ensuring compliance with payer guidelines. Additionally, this role supports efficient patient care and reimbursement by maintaining detailed documentation and coordinating closely with clinical, billing, and administrative teams.
What You'll Do - Secure prior authorizations and pre-certifications for medical procedures, tests, treatments, and services in a timely and efficient manner to prevent delays in patient care and reimbursement.
- Initiate and maintain communication with insurance payors to verify patient eligibility, benefits, and coverage details, including the identification of authorization and pre-certification requirements for scheduled services.
- Prepare, review, and submit complete and accurate authorization requests, ensuring compliance with individual payor guidelines and internal policies to minimize denials or rework.
- Proactively track, monitor, and follow up on all pending authorization requests, resolving issues and obtaining approvals before scheduled service dates.
- Maintain organized, detailed, and up-to-date documentation of all authorization activities, correspondence, and outcomes in electronic health records (EHR) or applicable systems, in accordance with regulatory and organizational standards.
- Regularly review and stay informed on updates to payer authorization protocols, policy changes, and payer-specific rules, communicating changes to relevant team members to ensure consistent compliance.
- Collaborate with clinical, billing, and administrative staff to ensure proper alignment of authorizations with scheduled services and claims processing.
- Support departmental goals by assisting with additional duties or special projects as assigned, contributing to the continuous improvement of workflows and patient access processes.
What You'll Need - High school diploma or equivalent required; associate’s or bachelor’s degree in a healthcare-related field preferred.
- Minimum of 2 years of experience in medical insurance verification, prior authorization, or related healthcare administrative work.
- Thorough knowledge of insurance plans, payor authorization requirements, and medical terminology, with the ability to interpret coverage and eligibility information.
- Proficiency in using electronic health records (EHR) systems and payer portals, along with strong computer skills including Microsoft Office.
- Strong attention to detail, organizational skills, and the ability to manage multiple requests and deadlines in a fast-paced environment.
- Excellent communication and interpersonal skills, with the ability to interact professionally with payors, clinical staff, and internal departments.
Why BrightSpan?- Competitive compensation among our industry competitors;
- Medical, dental and vision insurance;
- FSA & HSA plans available;
- Paid time off and holidays;
- Opportunities for professional and career development in a growing organization;
The Pay Range For This Role Is 50,000 - 55,000 USD per year(Remote (United States))
Job Tags
Work at office, Remote work,