Prior Auth Rep

Baystate Health • Holyoke, MA

15h • Remote

About The Position

Baystate Health is seeking a part-time Prior Authorization Specialist for its Contact Center. This fully remote role is available to candidates working within Massachusetts and Connecticut. The specialist supports referrals and authorizations for specialty services and testing throughout Baystate Health, working with providers, clinical teams, physician offices, insurance companies, patients, and families to help ensure timely access to care. The role involves accurate processing and documentation, resolving authorization issues, and addressing time-sensitive requests while providing helpful service and collaborating with healthcare professionals and customers.

The position is 20 hours per week, Monday through Friday, with hours scheduled between 8:00 AM and 5:00 PM. There is no weekend or on-call requirement. The required education is a GED or HiSET. Required experience includes 1–3 years of medical insurance knowledge. The listed compensation range is $23.46–$31.91 per hour, with a midpoint of $26.97.

Baystate Health describes itself as an integrated healthcare system serving communities throughout western Massachusetts. Benefits may be available depending on eligibility and include medical, dental, and vision coverage; tuition assistance, CEUs, and professional development; career growth opportunities; retirement savings with an employer match; and paid time off. Sign-on bonuses may apply to eligible external hires subject to stated conditions.

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 according to urgency and designated criteria.
• Provide internal and external customers with guidance and support on 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, 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.
• Paid time off for eligible employees.
• Sign-on bonuses may be available to eligible external hires; conditions apply.

What This Job Offers

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