Prior Authorization Specialist

Mass General Brigham•Boston, MA

2d•$20 - $28•Remote

About The Position

The Prior Authorization Specialist reviews and processes prior authorization and referral requests for medical services in accordance with 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 records authorization outcomes and payer communications in electronic health records. This fully remote, full-time role works Monday through Friday. Preferred hours are 8:00 a.m.–4:30 p.m. or 8:30 a.m.–5:00 p.m. The position is based at The Brigham and Women's Hospital, Inc., with a scheduled 40-hour workweek.

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 experience in medical authorization or a related field.
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 appropriate CPT codes for prior authorization or referrals when needed.
Refer patients to financial counseling when appropriate.
Inform patients of authorization concerns before admission or a procedure and coordinate with appropriate parties to facilitate authorization.
Collaborate with other departments and 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 explain them as needed.
Gather and submit complete medical documentation in alignment with HIPAA standards.
Document authorization outcomes and payer communications in electronic health records.