Prior Authorization Specialist

🔥 18 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Mass General Brigham

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📚 Education

Consulting • Healthcare • Education

Mass General Brigham is a large integrated academic healthcare system centered in Massachusetts that operates world-class hospitals, community health centers, and virtual care services, providing comprehensive patient care across specialties. It conducts extensive clinical and biomedical research, running thousands of clinical trials and advanced institutes in areas like gene and cell therapy and personalized medicine. The organization also provides medical education and training programs, workforce development, and operates a health plan and innovation/commercialization activities.

📋 Description

• Review and process prior authorization and referral requests for medical services according to organizational policies and payer requirements • Ensure insurance eligibility, coordination of benefits, site-of-care compliance, and medical necessity • Gather and submit complete medical documentation in alignment with HIPAA standards • Accurately document authorization outcomes and payer communications in the electronic health record • Secure insurance authorizations within appropriate timeframes • Collect and accurately enter information required by third parties for precertification of procedures, tests, and imaging • Collaborate with ordering clinicians to ensure proper CPT codes are submitted • Refer patients to financial counseling as appropriate • Inform patients of authorization concerns before admission or procedures • Coordinate with appropriate parties and departments to resolve complex authorization issues • Update authorization status in the system and complete workflow • Respond to internal and external inquiries regarding authorization decisions and provide explanations

🎯 Requirements

• High School Diploma or Equivalent required • Medical authorization or related field experience 1-2 years preferred • Epic experience 0-1 year preferred • Excellent attention to detail and organizational skills • Strong communication and interpersonal skills • Knowledge of medical terminology and medical insurance benefits, including a complete understanding of the coordination of benefits • Familiarity with computer systems and databases • Ability to work independently and as part of a team • Ability to work in a fast-paced environment • Must comply with HIPAA standards

🏖️ Benefits

• Comprehensive benefits • Career advancement opportunities • Differentials • Premiums • Bonuses as applicable • Recognition programs • Reasonable accommodation for individuals with disabilities