Neurology Prior Authorization Pro — Faster Care

Brigham and Women's Hospital; Boston (MA); Hybrid; USD 55,000 - 75,000; Full time

Job summary

The Brigham and Women's Hospital, Inc. in Boston, MA seeks an experienced Prior Authorization Specialist II to support Neurology revenue cycle operations. You will obtain authorizations, verify eligibility, process referrals, and handle denials and appeals with payers.

Strong attention to detail and effective communication are essential. Work closely with providers, clinical teams, and revenue cycle staff to ensure timely processing and documentation, while maintaining high levels of customer

Qualifications

• High School Diploma or Equivalent required.
• Experience in lieu of a degree not accepted.
• 2–3 years of medical authorization experience and Epic experience 0–1 year preferred.

Responsibilities

• Obtain insurance authorizations prior to patient services.
• Ensure all required insurance referrals are received and properly documented.
• Perform demographic and insurance eligibility checks in Epic, NEHEN, and payer systems.
• Facilitate referral and prior authorization requests with payers and pharmacies via phone, fax, and portals.
• Collect, review, and submit documentation to support medical necessity and payer requirements.
• Collaborate with providers and clinical staff to support authorization requests, reconsiderations, and appeals.
• Independently manage complex, high-cost or time-sensitive authorization requests and escalate as needed.
• Maintain accurate documentation of all authorization and referral activity in Epic.

Skills

Attention to detail

Communication skills

Medical terminology

Insurance benefits

Computer systems

Databases

Teamwork

Independence

Fast-paced

Education

High School Diploma or Equivalent

Experience in lieu of degree

Tools

Epic

NEHEN

Job description

The Brigham and Women's Hospital, Inc. in Boston, MA seeks an experienced Prior Authorization Specialist II to support Neurology revenue cycle operations. You will obtain authorizations, verify eligibility, process referrals, and handle denials and appeals with payers.

Strong attention to detail and effective communication are essential. Work closely with providers, clinical teams, and revenue cycle staff to ensure timely processing and documentation, while maintaining high levels of customer