Prior Authorization Specialist

🔥 13 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $25 - $30 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Screen and prioritize prior-authorization and coordination-of-specialized-services requests • Verify patient insurance and obtain authorizations through Epic and payer portals • Process authorization requests for inpatient, outpatient, and ancillary services • Authorize specified services under manager supervision and refer clinically complex requests for review • Coordinate financial clearance, pre-registration, demographic and insurance verification activities • Obtain referral authorizations and precertification numbers • Answer ACD calls and emails from providers, patients, and departments • Verify member eligibility and enter required information into CCMS or Facets • Inform callers and providers about network providers, services, benefits, and authorization decisions • Monitor and clear registration and prior-authorization work queues • Obtain, document, and link referrals and prior authorizations to scheduled services in Epic • Collaborate with patients, providers, physicians, practices, insurance carriers, case management, and Patient Financial Counseling • Coordinate peer-to-peer reviews and escalate denied or financially uncleared accounts • Interview patients, families, or referring physicians to obtain demographic, financial, and insurance information • Reconcile registration and insurance information with payer records • Refer self-pay or unresolved-insurance patients to Patient Financial Counseling • Maintain confidentiality and comply with healthcare collection laws, regulatory policies, and organizational procedures • Meet productivity, quality, accuracy, and turnaround-time expectations • Participate in training, quality audits, onboarding, and process-improvement initiatives • Report faulty systems or equipment to the appropriate support teams • Perform other related duties as assigned

🎯 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, healthcare office, or hospital administration required • Meditech experience strongly preferred • Experience using insurance payer websites, such as Blue Cross Blue Shield and Medicare • Customer service experience preferred • Experience with insurance verification, prior authorization, pre-certification, and financial clearance processes • Bilingual preferred • Ability to process high-volume requests with a 95% or greater accuracy rate • Ability to prioritize workload and process referrals and authorization requests within specified turnaround timeframes • Strong oral and written communication skills • 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 • Experience within Epic preferred • Technical proficiency with Epic work queues and ancillary systems, including ADT/Prelude/Grand Centrale • Microsoft Suite proficiency, specifically Excel, Word, Outlook, and Zoom • Knowledge of medical terminology and/or coding • Ability to maintain strict confidentiality of personal, health-sensitive, financial, and medical information • Ability to make independent decisions under pressure • Ability to multitask, manage complex processes, and maintain attention to detail

🏖️ 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 other development opportunities • Remote work arrangement