Prior Auth Rep

Baystate Health; Holyoke (MA); Remote; USD 32.000 - 44.000; Vollzeit

Zusammenfassung

Baystate Health is seeking a Prior Authorization Specialist to join our Contact Center. This fully remote role supports referrals and authorizations for specialty services and testing across Massachusetts and Connecticut, working closely with providers, insurance companies, and patients to ensure timely access to care.

The role involves processing referrals, monitoring denials, and maintaining accurate documentation while staying current with changing authorization requirements.

Qualifikationen

• 1-3 years of medical insurance knowledge.
• Proficiency with Microsoft Office (Word and Excel).
• Experience with CIS inbox and EMR preferred.

Aufgaben

• 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.

Kenntnisse

Medical insurance knowledge

Ausbildung

GED/HiSET

Tools

Microsoft Office (Word)

Microsoft Excel

CIS inbox

EMR

Jobbeschreibung

At Baystate Health we respect the privacy of our candidates and recruits. Please note that we will not contact candidates directly to ask for personal information over the phone, such as date of birth, social security number, or any other private financial information. Learn More

Prior Authorization Specialist – Contact Center

Prior Authorization Specialist in Holyoke, MA | Baystate Health Careers

Department: Contact Center

Location: Remote, Massachusetts & Connecticut

Job Type: Full-Time

Shift: Days

Make an Impact with Baystate Health

Baystate 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.

The 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.

Job Type: Full-Time

Shift: Days

Hours: Full-time, 40 hours per week

Schedule: Monday-Friday, with hours scheduled between 8:00 AM and 5:00 PM

On-Call Requirement: None

Other 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.

Depending on eligibility, benefits may include:

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.

Sign-On Bonuses: If applicable, Sign-On bonuses are paid to external hires only and are not applicable to internal or company transfers, unless otherwise specified. Former employees are eligible after one-year post-separation from Baystate Health.

Retirement: Retirement savings and employer match.

Paid Time Off: Generous PTO for eligible employees.

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

• Knowledge of medical terminology preferred.
• Proficiency with Microsoft Office, Word, and Excel.
• Experience with CIS inbox and EMR.

Start Your Career at Baystate Health

You Belong at Baystate.

Education:

GED or HiSET (Required)

Certifications:

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