Patient Access and Authorization Specialist

Patient Access and Authorization Specialist

NorthStar Behavioral Health is seeking an organized and professional Patient Access and Authorization Specialist to join our team. The Patient Access and Authorization Specialist plays a key role in the revenue cycle by bridging gaps among patients, clinical teams, and insurance providers. Their primary responsibility is to verify insurance eligibility and secure prior authorizations to ensure patients receive timely care while minimizing unexpected financial barriers.

About the role

NorthStar Behavioral Health is a full-service non-profit behavioral healthcare agency. Since 1976, NorthStar Behavioral Health has been ensuring access, safety, and quality for our clients in Hamilton County and the Greater Cincinnati area. Every day, we support individuals on their journey to recovery, healing, and hope - and we're just as committed to creating a workplace where our employees can thrive.

Responsibilities

• Verify patient insurance eligibility and benefits before scheduled services.
• Confirm policy effective dates and coverage limits.
• Determine patient financial responsibility, including copayments, coinsurance, deductibles, and out-of-pocket expenses.
• Obtain and process prior authorizations, precertification, and referrals from insurance carriers.
• Gather required clinical documentation from providers.
• Review medical documentation to support authorization requests.
• Communicate with clinical staff and insurance representatives regarding authorization status and requirements.
• Maintain detailed records of all authorization activities and payer communications.
• Ensure compliance with HIPAA, payer guidelines, and organizational policies.
• Review authorization denials and assist in preparing and submitting appeals and reconsideration requests.
• Collaborate with billing and revenue cycle teams to resolve insurance-related issues and prevent claim denials related to authorizations.

Requirements

• High school diploma or equivalent; Associate's degree preferred.
• 3+ years of continuous experience in behavioral healthcare registration, patient access, insurance verification, and prior authorization.
• Knowledge of commercial, Medicare, Medicaid, and managed care insurance plans.
• Familiarity with medical terminology, CPT, ICD-10, and HCPCS codes.
• Strong attention to detail.
• Experience using electronic health records (EHR) and practice management systems.
• Strong organizational, communication, and problem-solving skills.
• Ability to manage multiple priorities in a fast-paced healthcare environment.

Preferred Skills

• Certified Healthcare Access Associate (CHAA) or similar certification.
• Experience with revenue cycle management processes.
• Knowledge of payer authorization requirements and denial management.
• Strong customer service and patient advocacy skills.
• Ability to pass a criminal background and drug screen.
• Current vaccination for tuberculosis (TB) or willingness to be vaccinated upon hire.