Prior Authorization Specialist

Job not on LinkedIn

🔥 37 minutes ago

🦌 Connecticut, Massachusetts – Remote

🦌 Connecticut – Remote 🍂 Massachusetts – Remote

💵 $23 - $31 / hour

⏱ Part Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Baystate Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1873

🏥 Healthcare

🧘 Wellness

📚 Education

Healthcare • Wellness • Education

Baystate Health is a regional integrated health system serving western Massachusetts, providing hospital-based and outpatient care including emergency services, primary and specialty care, surgery, oncology, cardiology, pediatrics, radiology, and maternal health. It operates multiple hospitals and clinics, runs community health and wellness programs, conducts clinical research and trials, and serves as the regional campus for UMass Chan Medical School with extensive medical education and residency programs. Baystate also offers patient-facing digital tools (MyBaystate), fundraising through a foundation, and community outreach and volunteer initiatives.

📋 Description

• Process referrals and prior authorizations for specialty services and testing • Collaborate with clinical team members, physician offices, agencies, and insurance companies to obtain required information • Monitor denial and no-referral reports • Obtain required authorizations and referrals • Process appeals for denied claims • Manage and maintain the Electronic Referral Tracking Report • Prioritize requests based on urgency and designated criteria • Provide guidance and support on referral and authorization questions and processing issues • Communicate authorization decisions and timely updates to providers, staff, patients, and families • Maintain accurate documentation in patients' medical records • Update referral and authorization statuses • Stay current with insurance authorization requirements and communicate changes, trends, and process updates

🎯 Requirements

• 1-3 years of medical insurance knowledge • Proficiency with Microsoft Office, Word, and Excel • Experience with CIS inbox and EMR • GED or HiSET (Required) • Bilingual in English/Spanish preferred • Knowledge of medical terminology preferred

🏖️ Benefits

• Medical, dental, and vision coverage, including local Health New England plans (depending on eligibility) • Tuition assistance • CEUs • Professional development opportunities • Clinical advancement opportunities • Leadership development • Internal career opportunities • Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts • Retirement savings and employer match (depending on eligibility)