Prior Authorization Specialist, Per Diem

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $25 - $31 / hour

⏱ Part 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.

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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

• Screen and prioritize prior-authorization and specialized-services requests for inpatient, outpatient, and ancillary services • Process requests and authorize specified services under departmental guidelines and manager supervision • Refer requests requiring clinical judgment to the Prior Authorization Clinician, Manager, or Medical Director • Answer ACD calls, verify member eligibility, enter information into CCMS or Facets, and redirect calls as needed • Identify network providers, services, and member benefits; communicate authorization decisions to providers • Coordinate resolution of escalated member and provider inquiries • Monitor registration and prior-authorization work queues and obtain required patient and payer financial-clearance elements • Obtain and document referrals and prior authorizations in Epic before scheduled services • Coordinate with practices, physicians, insurers, patients, case management, and Patient Financial Counseling • Serve as liaison between physicians and payers for peer-to-peer reviews • Escalate denied or financially uncleared accounts according to policy • Interview patients, families, and referring physicians to collect financial, demographic, insurance, and reimbursement information • Validate and reconcile registration and insurance information, eligibility, primary care physician, subscriber, employer, and appointment data • Refer self-pay or unresolved-insurance patients to Patient Financial Counseling • Maintain confidentiality and comply with healthcare collection laws and regulatory policies • Meet productivity, quality, accuracy, and turnaround-time standards; undergo quality audits • Participate in training, educational offerings, orientation of new personnel, and process-improvement initiatives • Report faulty systems or hardware to the Help Desk and coordinate equipment servicing • 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, specifically in a high-volume data entry office, customer service call center, healthcare 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 • Basic medical terminology and ICD-9/CPT coding knowledge helpful • Epic experience 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 • Strong oral and written communication, collaboration, organization, multitasking, judgment, customer service, and decision-making skills • Bilingual preferred • Certificates, licenses, and registrations: None required

🏖️ 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 position • Per diem, part-time schedule