Prior Authorization Specialist, Per Diem

🕒 July 23

🇺🇸 United States – Remote

💵 $25 - $31 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 44%

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 process prior-authorization and specialized-service requests for inpatient, outpatient, and ancillary services • Authorize specified services under manager supervision and refer requests requiring clinical judgment to clinicians, managers, or the Medical Director • Prioritize incoming requests and meet productivity, quality, accuracy, and turnaround-time metrics • Support Prior Authorization Clinicians • Answer ACD calls and emails, verify member eligibility, and enter request information into CCMS or Facets • Inform callers and providers about network providers, services, member benefits, and authorization decisions • Coordinate resolution of escalated member and provider inquiries • Monitor registration and prior-authorization work queues and obtain required financial-clearance elements • Obtain and document referrals, prior authorizations, pre-certifications, and approval numbers in Epic and relevant practice-management systems • Collaborate with practices, physicians, insurance carriers, patients, case management, Patient Financial Counseling, and other stakeholders • Serve as liaison between physicians and payers for peer-to-peer review • Escalate denied or financially uncleared accounts according to policy • Interview patients, families, or referring physicians to obtain demographic, insurance, and financial information • Validate and reconcile insurance eligibility, plan, subscriber, employer, and appointment information • Refer self-pay or unresolved-insurance patients to Patient Financial Counseling • Maintain confidentiality of patient financial and medical records and report compliance concerns • Participate in training, orientation of new personnel, and process-improvement initiatives • Contact the Help Desk or appropriate vendor regarding faulty systems and equipment • Perform other related duties as assigned

🎯 Requirements

• High school diploma or GED required • 4-5 years of office experience, specifically in a high volume data entry office, customer service call center or health care office or hospital administration • Experience using insurance payer websites (e.g., Blue Cross Blue Shield, Medicare) • Experience with insurance verification, prior authorization, pre-certification and financial clearance process • Ability to process high volume of requests with a 95% or greater accuracy rate • Ability to prioritize workload while processing referrals and authorization requests within specified turnaround timeframes • Thorough knowledge of financial clearance process • Familiarity with insurances, referral authorizations and third-party billing procedures • Basic computer proficiency, including Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom • Bilingual preferred • Customer service experience preferred • Knowledge of basic medical terminology and ICD-9/CPT coding helpful • Knowledge of and experience within Epic preferred • Technical proficiency within Epic work queues and applicable ancillary systems, including ADT/Prelude/Grand Centrale • Ability to maintain confidentiality of personal/health-sensitive information • Ability to multitask, manage complex processes, maintain urgency, and make independent decisions under pressure • Must adhere to applicable laws, regulations, policies, procedures, and BMC RESPECT behavioral standards

🏖️ 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 sponsored by BMC • Development opportunities • Remote work