Prior Authorization Specialist

Mass General Brigham•Somerville, MA

3d•$28•Remote

About The Position

Reviews and processes prior authorization and referral requests for medical services in accordance with organizational policies and payer requirements. 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. Accurately documents authorization outcomes and all payer communications in the electronic health record.

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.
Employees must use a stable, secure, and compliant workstation in a quiet environment.
Teams video is required and must be accessed using MGB-provided equipment.

Responsibilities

Work as part of a group to secure insurance authorizations in an appropriate timeframe.
Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.
When unclear, collaborates with ordering clinicians to ensure the proper CPT codes are submitted for prior authorization or referrals.
Refer patients to financial counseling, as appropriate.
Inform patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, collaborating with other departments/offices to resolve complex authorization issues.
Update authorization status in system and complete workflow.
Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed.