Job Description

Position Details:

Hours : Monday–Friday, 40 hours a week

Location: Onsite in Erie, PA

Overview:

As the Insurance Verification & Authorization Specialist, you will play a critical role in ensuring timely access to treatment by managing all aspects of the prior authorization process. This includes verifying insurance coverage, securing authorizations, and supporting the Accounts Receivable team in resolving claims and reducing denials. You’ll collaborate with clinical staff, patients, and insurance providers to streamline workflows and maintain accurate documentation within Carelogic.

This position is ideal for someone who thrives in a detail-oriented, fast-paced environment and is passionate about improving access to care through efficient insurance processes.

What You’ll Bring:

• Expertise in insurance verification, prior authorization, and payer communication
• Ability to navigate electronic, telephonic, email, and fax-based interactions with insurers
• Strong understanding of medical necessity documentation and peer-to-peer review escalation
• Commitment to maintaining accurate records and supporting team collaboration
• A proactive approach to identifying trends and resolving authorization-related issue

What You’ll Have:

• High School Diploma or GED required
• Minimum 2 years of experience in insurance verification and prior authorization processes  
• Strong knowledge of medical and behavioral health terminology 
• Advanced proficiency in Microsoft Office Suite, especially Excel (pivot tables, formulas, filtering)
• Familiarity with Medicaid and commercial payer guidelines
• Excellent organizational, written, and verbal communication skills
• Ability to handle confidential information in compliance with HIPAA
• Experience working independently and collaboratively in a healthcare setting

A Typical Day May Include:

• Verifying insurance eligibility and benefit levels for upcoming services
• Coordinating with payers to obtain authorizations or Blanket Denial Letters (BDLs)
• Communicating with patients and clinical staff to gather necessary documentation
• Updating insurance and authorization records in Carelogic, including scanned documents
• Running and reviewing bi-weekly EVS reports to maintain up-to-date insurance information
• Prioritizing urgent cases and documenting all interactions with reference numbers and dates
• Maintaining and tracking BDLs to prevent lapses in authorization
• Supporting claim resolution efforts and identifying trends impacting reimbursement
• Participating in mandatory trainings and adapting to evolving program needs

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