Job Overview
Location
Indiana, USA
Job Type
Full-time
Category
Software Engineering
Date Posted
March 10, 2026
Full Job Description
đź“‹ Description
- • Join Lehigh Valley Health Network (LVHN), a nationally recognized and forward-thinking healthcare organization, and contribute to a career that makes a tangible difference in patient care. LVHN is renowned for its commitment to excellence, consistently ranked among the "Best Hospitals" by U.S. News & World Report for an impressive 23 consecutive years. As a Magnet™ Hospital, honored five times for nursing excellence, and with multiple facilities receiving 'A' grades for patient safety from The Leapfrog Group, LVHN embodies a culture of teamwork, compassion, and cutting-edge technology.
- • In this vital role as an Authorization Specialist, you will be instrumental in ensuring patients receive the necessary approvals for their medical services. Your primary responsibility will be to obtain benefits and authorizations for a wide range of healthcare provisions, including surgical procedures, diagnostic testing, prescribed medications, and outgoing referrals. This is a critical function that directly impacts patient access to care and the financial health of the organization.
- • You will meticulously determine the specific authorization protocols for each health plan, navigating the complexities of various insurance providers. This involves in-depth verification of benefits, understanding medical necessity requirements, and ensuring all documentation aligns with payer policies and patient treatment plans.
- • A key aspect of your role will be to collaborate closely with physicians and their office staff. You will act as a liaison, gathering essential clinical information and communicating effectively to ascertain the appropriate authorization based on medical necessity and the proposed treatment plan.
- • You will conduct thorough medical necessity checks, critically evaluating if the proposed procedure and diagnosis adequately support the medical necessity as required by insurance companies.
- • A significant part of your daily operations will involve direct and indirect communication with insurance companies. This includes verifying insurance coverage, obtaining precertification approvals, and ensuring all necessary documentation is submitted accurately and on time.
- • You will be responsible for reviewing and monitoring work queues and schedules to guarantee that proper and accurate authorizations are secured *prior* to the patient's scheduled visit. Proactive management of these tasks is crucial to prevent delays in care and ensure a smooth patient experience.
- • Maintaining compliance with established benchmark data regarding registered accounts versus scheduled procedures will be a key performance indicator. Your attention to detail and efficiency will directly contribute to meeting these organizational goals.
- • Furthermore, you will play a role in financial clarity for patients by determining their estimated financial responsibility. This involves utilizing insurance verification information, understanding payer contracts, and applying self-pay guidelines to provide patients with an accurate understanding of their out-of-pocket costs.
- • This position requires a strong understanding of patient rights and relevant laws, such as HIPAA, ensuring all interactions and data handling are conducted with the utmost confidentiality and integrity.
- • You will become proficient in utilization management processes, adhering to established standards and managed care principles. This includes staying updated on evolving insurance regulations and best practices.
- • The role demands a solid grasp of standard medical practices and the intricate details of insurance benefit structures, enabling you to effectively advocate for patient needs and navigate the authorization process.
- • By excelling in this role, you will contribute significantly to LVHN's mission of providing exceptional healthcare, ensuring that patients can access the treatments they need without unnecessary administrative hurdles. Your work directly supports the seamless delivery of care and reinforces LVHN's reputation for quality and patient-centered service.
- • This is a remote position, offering the flexibility to work from Pennsylvania, with a standard Monday-Friday, 8:00 AM to 4:30 PM work schedule. You will be part of the COH-Precertification Department, a dedicated team focused on streamlining the authorization process.
- • Embrace an opportunity to grow your career within a leading healthcare network that values its employees and is committed to their professional development. Your contributions will be recognized and valued in an environment that fosters innovation and excellence.
🎯 Requirements
- • High School Diploma or GED with specialized training in insurance, coding, billing, or similar healthcare certificate programs.
- • Minimum of 1 year of experience in a healthcare setting specifically involving insurance verification and/or authorizations.
- • Familiarity with healthcare billing procedures and payer reimbursement processes.
- • Knowledge of patient rights and relevant privacy laws, such as HIPAA.
- • Proficiency in utilization management processes, standards, and managed care principles.
🏖️ Benefits
- • Competitive salary and comprehensive health benefits package.
- • Opportunities for professional development and continuing education.
- • Generous paid time off and holiday schedule.
- • Retirement savings plan with employer match.
- • Employee assistance program and wellness initiatives.
Skills & Technologies
Remote
About Lehigh Valley Health Network, Inc.
Lehigh Valley Health Network is a regional, non-profit health system headquartered in Allentown, Pennsylvania. It operates eight hospital campuses, numerous outpatient centers and physician practices serving eastern Pennsylvania and western New Jersey. The network provides primary, specialty, acute and tertiary care, including Level I trauma, cancer, heart, pediatric and rehabilitation services, and houses a medical school campus in partnership with the University of South Florida. Employing over 20,000 clinicians, researchers and support staff, LVHN focuses on community health, innovation and value-based care delivery across its integrated delivery system.
