Prior Authorization Specialist I – Patient Access Services

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $25 - $30 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Boston Medical Center (BMC)

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1996

Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.

📋 Description

• Coordinate financial clearance activities, including pre-registration, insurance verification, referrals, authorizations, and precertifications • Prioritize and process incoming prior authorization requests • Refer requests requiring clinical judgment to the Prior Authorization Clinician, Manager, or Medical Director • Answer ACD calls, verify member eligibility, and enter information into CCMS or Facets • Identify network providers, services, and member benefits • Inform providers of authorization decisions and coordinate escalated inquiries • Monitor registration and prior authorization work queues and obtain required financial clearance elements • Navigate BMC and payer policies to obtain approvals for scheduled care • Obtain and document referrals and prior authorizations in Epic • Collaborate with practices, physicians, insurance carriers, patients, and departments to secure required permissions • Liaise between physicians and payers for peer-to-peer reviews • Escalate denied or uncleared accounts according to policy • Interview patients, families, and referring physicians to collect demographic, financial, and insurance information • Validate and update demographic, insurance, eligibility, subscriber, employer, and appointment information • Refer self-pay or unresolved-insurance patients to Patient Financial Counseling • Maintain confidentiality and comply with healthcare collection laws and regulatory policies • Handle telephone calls and emails according to customer service standards • Participate in training, quality audits, orientation of new personnel, and process improvement initiatives • Report faulty systems or equipment and perform other assigned duties

🎯 Requirements

• High school diploma or GED required • Associate’s Degree or higher preferred • 4-5 years of office experience in a high-volume data entry office, customer service call center, health care office, or hospital administration • Experience using insurance payer websites, such as Blue Cross Blue Shield and Medicare • Experience with insurance verification, prior authorization, pre-certification, and financial clearance processes • Ability to process high-volume requests with a 95% or greater accuracy rate • Ability to prioritize workload within specified turnaround timeframes • Thorough knowledge of the financial clearance process • Familiarity with insurance, referral authorizations, and third-party billing procedures • Knowledge of basic medical terminology and ICD-9/CPT coding helpful • Knowledge of and experience within Epic preferred • Technical proficiency in Epic work queues and ancillary systems, including ADT/Prelude/Grand Centrale • Basic computer proficiency, including Microsoft Excel, Word, Outlook, and Zoom • Ability to maintain strict confidentiality of personal and health-sensitive information • Ability to make independent decisions under pressure and manage complex processes • Bilingual preferred

🏖️ Benefits

• Medical, dental, vision, and pharmacy benefits • Contract increases • Flexible Spending Accounts • 403(b) savings matches • Earned time cash out • Paid time off • Career advancement opportunities • Resources to support employee and family wellbeing • Educational offerings and development opportunities • Remote work