Prior Auth Rep

Baystate Health • Holyoke, MA

10h • Remote

About The Position

The Prior Authorization Specialist supports the referral and authorization process for specialty services and testing provided throughout Baystate Health. The role works with providers, clinical teams, physician offices, insurance companies, patients, and families to ensure referrals and authorizations are accurately processed, documentation is complete, and time-sensitive requests are addressed promptly. This is a fully remote opportunity for candidates working within Massachusetts or Connecticut.

Requirements

• GED or HiSET.
• 1–3 years of medical insurance knowledge.
• Proficiency with Microsoft Office, Word, and Excel.

Nice To Haves

• Bilingual in English and Spanish.
• Knowledge of medical terminology.
• Experience with CIS inbox and EMR.

Responsibilities

• Process referrals and prior authorizations for specialty services and testing, ensuring requests are accurate, timely, and properly documented.
• Collaborate with clinical team members, physician offices, agencies, and insurance companies to obtain information needed to complete referrals and authorizations.
• Monitor denial and no-referral reports, obtain required authorizations and referrals, and process appeals for denied claims.
• Manage and maintain the Electronic Referral Tracking Report, ensuring information is accurate and requests are prioritized based on urgency and designated criteria.
• Provide guidance and support to internal and external customers regarding referral and authorization questions and processing issues.
• Communicate authorization decisions and provide timely updates to referring providers, ordering providers, staff, patients, and families.
• Maintain accurate documentation in the patient's medical record and update referral and authorization statuses as appropriate.
• Stay current with insurance authorization requirements and communicate changes, trends, and process updates to providers and staff.

Benefits

• Medical insurance coverage, including local Health New England plans.
• Dental insurance coverage.
• Vision insurance coverage.
• Tuition assistance.
• CEUs and professional development opportunities.
• Clinical advancement, leadership development, and internal career opportunities.
• Sign-on bonuses for eligible external hires, subject to the stated conditions.
• Retirement savings and employer match.
• Generous paid time off for eligible employees.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED