Per Diem Prior Auth

Baystatehealth; United States; Teletrabalho; USD 32 000 - 44 000; Tempo parcial

Vantagens oferecidas por esta oferta de emprego

Health benefits

Tuition assistance

Career growth opportunities

Retirement plan

Resumo da oferta

Baystate Health is seeking a Per Diem Prior Authorization Specialist to support referrals and authorizations for specialty services and testing. This remote role within Massachusetts and Connecticut collaborates with providers, insurance companies, and patients to ensure timely access to care and accurate documentation.

The position emphasizes problem-solving, independence, and high-quality service while coordinating with clinicians and staff across Baystate Health.

Qualificações

• 1-3 years of medical insurance knowledge.
• Bilingual in English/Spanish preferred.
• Proficiency with Microsoft Office (Word & Excel).

Responsabilidades

• Process referrals and prior authorizations for specialty services and testing.
• Collaborate with clinical teams, physician offices, agencies, and insurance companies to obtain information.
• Monitor denial and no-referral reports and process appeals for denied claims.
• Manage the Electronic Referral Tracking Report and prioritize requests by urgency.
• Provide guidance and answers on referral/authorization questions to internal and external customers.
• Communicate authorization decisions to referring and ordering providers, staff, patients, and families.

Conhecimentos

Medical insurance knowledge

Bilingual English/Spanish

Microsoft Office (Word/Excel)

Formação académica

GED or HiSET

Ferramentas

CIS inbox

EMR

Descrição da oferta de emprego

Prior Authorization Specialist - Contact CenterPrior Authorization Specialist in Holyoke, MA | Baystate Health CareersDepartment: Contact CenterLocation: Remote, Massachusetts & ConnecticutJob Type: Per DiemShift: Days

Make an Impact with Baystate HealthBaystate Health is seeking a Prior Authorization Specialist to join our [Department/Team]. In this role, you will support the referral and authorization process for specialty services and testing provided throughout Baystate Health. Working closely with providers, clinical teams, physician offices, insurance companies, patients, and families, you will help ensure services are authorized and patients receive timely access to the care they need.The Prior Authorization Specialist role offers the opportunity to make a meaningful impact behind the scenes by ensuring referrals and authorizations are accurately processed, documentation is complete, and time-sensitive requests are addressed promptly. This position is ideal for someone who enjoys problem-solving, working independently, and providing excellent service while collaborating with a variety of healthcare professionals and customers.

Prior Authorization Specialist Will:

• 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 the 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, ensuring information is accurate and requests are prioritized 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 the status of referrals and authorizations as appropriate.
• Stay current with insurance authorization requirements and communicate changes, trends, and process updates to providers and staff.

Schedule Details

Job Type: Per DiemShift: DaysHours: Per DiemSchedule: Monday-Friday, with hours scheduled between 8:00 AM and 5:00 PMWeekend Requirement: NoneOn-Call Requirement: NoneOther Scheduling Requirements: This is a fully remote work opportunity for candidates working within Massachusetts & Connecticut.

Benefits That Support You

At Baystate Health, you get the best of both worlds: the resources, stability, and career opportunities of a large integrated healthcare system with the supportive culture of a community-focused organization.

• Competitive Pay & Benefits: Medical, dental, and vision coverage, including local Health New England plans.
• Tuition & Training: Tuition assistance, CEUs, and professional development opportunities.
• Career Growth: Clinical advancement, leadership development, and internal career opportunities.
• Regional Opportunities: Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts.
• Retirement: Retirement savings and employer match.

About Baystate Health

Baystate Health is an integrated healthcare system serving patients and communities throughout western Massachusetts. Our network includes Baystate Medical Center, Baystate Children's Hospital, Baystate Noble Hospital, Baystate Franklin Medical Center, Baystate Wing Hospital, Baystate Medical Practices, and Baystate Home Health & Hospice. Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health helps improve the health of the communities we serve.

Required Skills

1-3 years of medical insurance knowledge.

Preferred Qualifications & Skills

• Bilingual in English/Spanish preferred.
• Knowledge of medical terminology preferred.
• Proficiency with Microsoft Office, Word, and Excel.
• Experience with CIS inbox and EMR.

Education:

GED or HiSET (Required)

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum

$23.46 - $26.97 - $31.91

Equal Employment Opportunity Employer Baystate