Prior Authorization Specialist

Mass General Brigham • Boston, MA

2h • Remote

About The Position

The Prior Authorization Specialist reviews and processes prior authorization and referral requests for medical services according to organizational policies and payer requirements. The role ensures insurance eligibility, coordination of benefits, site-of-care compliance, and medical necessity by gathering and submitting complete medical documentation in alignment with HIPAA standards. The specialist accurately documents authorization outcomes and payer communications in electronic health records. This is a fully remote, full-time, Monday–Friday position, with preferred hours of 8:00 a.m.–4:30 p.m. or 8:30 a.m.–5:00 p.m. The role does not require patient care.

Requirements

• High school diploma or equivalent.
• Excellent attention to detail and organizational skills.
• Strong communication and interpersonal skills.
• Knowledge of medical terminology and medical insurance benefits, including 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.

Nice To Haves

• 1–2 years of medical authorization or related field experience.
• 0–1 year of Epic experience.

Responsibilities

• Work as part of a group to secure insurance authorizations within an appropriate timeframe.
• Collect and accurately enter information required by third parties for precertification of procedures, tests, and imaging.
• Collaborate with ordering clinicians to confirm the appropriate CPT codes for prior authorization or referrals when needed.
• Refer patients to financial counseling as appropriate.
• Inform patients of authorization concerns before an admission or procedure and coordinate with relevant parties to facilitate authorization.
• Collaborate with other departments or offices to resolve complex authorization issues.
• Update authorization status in the system and complete the workflow.
• Respond to internal and external inquiries about authorization decisions and provide explanations as needed.
• Gather and submit complete medical documentation in compliance with HIPAA standards.
• Document authorization outcomes and payer communications in electronic health records.

Benefits

• Competitive base pay.
• Comprehensive benefits.
• Career advancement opportunities.
• Differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate contributions and support professional growth.

What This Job Offers

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