Prior Authorization Specialist – Per Diem

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Boston Medical Center (BMC)

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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

• Responsible for screening prior-authorization and coordination of specialized services requests • Adheres to policies and procedures to comply with performance and compliance standards • Authorizes specified services under supervision according to departmental guidelines • Forwards specified requests to clinicians for review and processing • Answers ACD line calls from providers and departments and redirects as needed • Coordinates financial clearance activities by navigating pre-registration, obtaining referral authorizations • Maintains current knowledge of network resources for referrals and member needs • Collaborates with stakeholders in the financial clearance process

🎯 Requirements

• High school diploma or GED required • Associate’s Degree or higher preferred • 4-5 years of office experience in high volume data entry, customer service call center, or health care office • Experience using Insurance payer websites (i.e Blue Cross Blue Shield, Medicare, etc.) • Customer service experience preferred • Experience with insurance verification, prior authorization, pre-certification, and financial clearance process. • Bilingual preferred • Knowledge of financial clearance process • Familiarity with insurances, referral authorizations and third party billing procedures. • Knowledge of basic medical terminology and ICD-9/CPT coding is helpful. • Basic computer proficiency including Microsoft Suite applications, specifically Excel, Word, Outlook, and Zoom.

🏖️ Benefits

• Health insurance • Dental insurance • Vision insurance • Flexible Spending Accounts • 403(b) savings matches • Earned time cash out • Paid time off • Career advancement opportunities • Resources to support employee and family wellbeing