Boston Medical Center (BMC)
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.
Prior Authorization Specialist
Job not on LinkedIn
🔥 3 hours ago
📊 Check your resume score for this job
Improve your chances of getting an interview by checking your resume score before you apply.
Boston Medical Center (BMC)
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
• Monitors accounts routed to precertification and prior authorization work queues • Clears work queues by obtaining all payer specific financial clearance requirements in accordance with established management guidelines • Maintains knowledge of and complies with insurance companies’ requirements for obtaining pre-certifications/prior authorizations/referrals • Acts as subject matter experts in navigating both the BMC Community and the payer world • Supports BMC staff at all levels for hands-on help understanding and navigating financial clearance issues • Uses appropriate strategies to underscore the most efficient process to obtaining authorizations • Obtains and clearly documents all pre-certifications/prior authorizations for scheduled services prior to admission within the Epic environment • Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services • Communicates with patients, providers, and other departments such as Utilization Review to resolve any issues or problems with obtaining required pre-certifications/prior authorizations • Escalates emergent and elective accounts that have been denied or will not be financially cleared within 3 days of admission
🎯 Requirements
• High School Diploma or GED required • Associates degree or higher preferred • 4-5 years medical billing/denials/coding/and/or inpatient admitting experience desirable • General knowledge of healthcare terminology and CPT-ICD10 codes • Complete understanding of insurance is preferred • Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. • Knowledge of and experience within Epic is preferred. • Technical proficiency within assigned Epic work queues and applicable ancillary systems, including but not limited to: ADT/Prelude/Grand Central, HB & PB Resolute. • Proficiency in Microsoft Suite applications, specifically Excel, Word, and Outlook.
🏖️ Benefits
• medical • dental • vision • pharmacy • 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
Apply Now
