Full employer posting
Beacon Health System is hiring a full-time day shift Lead Prior-Auth Spec position for our Transfer Center Dispatch 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 Lead Prior-Auth Spec, you’ll report to the VP of Patient Access and evaluate referred services to determine authorization requirements based on government and commercial payer guidelines. You will gather and distribute clinical and coding documentation to support the authorization process and help ensure appropriate reimbursement. In addition, you’ll provide exceptional customer service by communicating with patients, families, visitors, and BMG associates with empathy and clarity regarding next steps in care.
You’ll also serve as a department resource when the Supervisor is unavailable and assist with training and lead responsibilities. Spanish speaking and writing skills are preferred. Lead Prior Authorization Specialist –
Serves as the primary contact and resource for all designated prior authorization needs. Identifies, collects, and coordinates clinical documentation to support qualification for ordered services. Evaluates orders for insurance coverage and authorization requirements.
Ensures carrier process requirements are met within contracted guidelines and required timeframes. Ensures proper testing is completed using available tools in accordance with provider preferences, testing criteria, insurance requirements, and modality ordering guidelines. Reviews and complies with additional requests.
Validates completed authorizations to ensure they correspond with the ordered service, code, timeframe, and provider. Supports the appeals process by communicating and coordinating resolution expectations with providers and authorization agents. Maintains standardized records to support effective coordination, tracking, and reporting of departmental activities and metrics.
Advocates for customers by recognizing when to challenge unfavorable prior authorization decisions. Disputes and negotiates, when necessary, on behalf of BHS and the customer to achieve a positive prior authorization outcome. Provides exceptional, customer-centered service during every encounter with patients, families, and associates.
Uses critical thinking skills to make decisions, identify problems, develop solutions, and assist with implementing changes. Escalates concerns when appropriate. Participates in performance improvement initiatives by following established work systems, identifying deviations or deficiencies in standards, systems, or processes, and communicating issues to supervisors or managers.
Prioritizes work effectively. Works efficiently in a fast-paced environment while maintaining accuracy. Understands the flow and rhythm of each task and connects activities to support convenient, coordinated, and patient-centered care.
Utilizes multiple software platforms, including EMRs, insurance websites, referral databases, and scheduling software, to support patient care. Assists with annual staff evaluations and provides ongoing feedback regarding team member performance. Assists others and accepts additional responsibilities as needed.
Enhances professional growth and development through approved in-service meetings and educational programs. Maintains current knowledge and stays informed of changes and updates related to insurance, departmental procedures, and organizational processes. Trains new team members and assists with staff scheduling.
Helps establish and manage new departmental processes to improve workflow efficiency. Serves as a point person within the department when the Supervisor or Practice Manager is unavailable. Provides leadership to team members by coordinating and prioritizing work, as well as offering assistance when needed.
Attends and participates in department meetings and is accountable for all information shared. Completes mandatory education, annual competencies, and department-specific training within established timeframes. Completes annual employee health requirements within established timeframes.
Maintains all required licenses, certifications, and registrations in good standing throughout the fiscal year. Direct patient care providers maintain current BCLS (CPR) certification and any other certifications required by their position or department. Consistently follows universal precautions, uses appropriate protective equipment, and practices proper ergonomic techniques to protect patients and self.
Adheres to regulatory requirements, survey processes, and compliance standards. Complies with all organizational and departmental policies. Remains available to work overtime and additional shifts or schedules as needed.
What You Bring You’ll bring strong communication, customer service, and analytical skills, along with the ability to work effectively with patients, providers, insurance payors, and internal teams. You demonstrate professionalism when handling sensitive and confidential information and remain composed in challenging situations. Your knowledge of medical terminology, CPT and ICD-10 coding, insurance requirements, referrals, and prior authorizations enables you to successfully navigate complex authorization processes and resolve issues efficiently.
You also possess strong organizational skills, attention to detail, and proficiency with Microsoft Office applications, including Outlook, Excel, and Word. Additionally, you promote collaboration and innovation to support quality patient care and continuous improvement in healthcare delivery. 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. Previous lead experience preferred.
Working knowledge of Microsoft Office applications, including Outlook, Excel, and Word.
Day shift · Monday - Friday
About the role
As a Lead Prior-Auth Spec, you’ll report to the VP of Patient Access and evaluate referred services to determine authorization requirements based on government and commercial payer guidelines. You will gather and distribute clinical and coding documentation to support the authorization process and help ensure appropriate reimbursement.