Prior Auth Rep

Baystatehealth; United States; Remote; USD 30,000 - 47,000; Part time

Benefits offered by this job

Medical, dental, and vision coverage

Tuition assistance

Career growth opportunities

Regional opportunities across Baystate

Sign-On bonuses (external hires only)

Retirement plan

Paid time off

Job summary

Baystate Health is seeking a Prior Authorization Specialist to join the Contact Center. This remote, part-time role supports referrals and authorizations for specialty services and testing across Massachusetts and Connecticut, coordinating with providers, offices, insurers, and patients to ensure timely access to care.

You will process referrals and authorizations, monitor denials, maintain documentation, and stay current with insurance requirements.

Qualifications

• 1-3 years of medical insurance knowledge.
• Bilingual English/Spanish preferred.
• Knowledge of medical terminology preferred.
• 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 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.

Skills

Medical insurance knowledge

Bilingual English/Spanish (preferred)

Medical terminology

Microsoft Office (Word, Excel)

CIS inbox and EMR experience

Education

GED or HiSET

Job description

Prior Authorization Specialist - Contact Center

Prior Authorization Specialist in Holyoke, MA | Baystate Health Careers

Department: Contact Center

Location: Remote, Massachusetts & Connecticut

Job Type: Part-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.

Schedule Details

• Job Type: Part-Time
• Shift: Days
• Hours: Part-time, 20 hours per week
• Schedule: Monday-Friday, with hours scheduled between 8:00 AM and 5:00 PM
• Weekend Requirement: None
• On-Call Requirement: None
• Other Scheduling Requirements: This is a fully remote work opportunity for candidates working within Massachusetts & Connecticut.

Benefits That Support You

• 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

• 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