Per Diem Prior Auth

Baystate Health • Holyoke, MA

1d • Remote

About The Position

Baystate Health is seeking a Prior Authorization Specialist to support the referral and authorization process for specialty services and testing throughout its healthcare system. The role works with providers, clinical teams, physician offices, agencies, insurance companies, patients, and families to ensure referrals and authorizations are accurately processed, documentation is complete, and time-sensitive requests are addressed promptly. It is suited to someone who enjoys problem-solving, working independently, providing excellent service, and collaborating with healthcare professionals and customers.

This is a per diem, fully remote position for candidates working within Massachusetts or Connecticut. Hours are scheduled Monday through Friday between 8:00 AM and 5:00 PM. There are no weekend or on-call requirements.

Requirements

• 1–3 years of medical insurance knowledge.
• GED or HiSET.

Nice To Haves

• Bilingual in English and Spanish.
• Knowledge of medical terminology.
• Proficiency with Microsoft Office, Word, and Excel.
• 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, keeping information accurate and prioritizing requests based on urgency and designated criteria.
• Serve as a resource for internal and external customers by providing guidance and support related to 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 status as appropriate.
• Stay current with insurance authorization requirements and communicate changes, trends, and process updates to providers and staff.

Benefits

• Medical, dental, and vision coverage, including local Health New England plans, depending on eligibility.
• Tuition assistance, CEUs, and professional development opportunities, depending on eligibility.
• Clinical advancement, leadership development, and internal career opportunities.
• Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts.
• Retirement savings and employer match, depending on eligibility.

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED