Prior Authorization Specialist

The General Hospital Corporation; United States; Remote; USD 29,000 - 39,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

Mass General Brigham Incorporated is seeking a Prior Authorization Specialist to coordinate between the hospital, insurers, and patients, ensuring timely pre-authorization and reimbursement for services. You will verify coverage, educate patients, and assist with denials and appeal processes.

The role emphasizes collaboration with physicians and nurses, accurate documentation, and adherence to industry regulations, offering a remote option with a standard daytime schedule.

Qualifications

• Epic experience and referrals/authorization experience are highly preferred.
• Healthcare administration or insurance verification experience is required or 2-3 years in related roles.

Responsibilities

• Verify insurance coverage and eligibility before procedures or admissions.
• Obtain pre-authorization from insurance for procedures and tests.
• Collaborate with providers for accurate documentation for claims.
• Educate patients about benefits, coverage, and financial responsibilities.
• Process and submit claims accurately and timely in line with regulations.

Skills

Epic experience

Healthcare administration

Insurance verification

Education

High School Diploma or Equivalent

Associate's Degree Related Field of Study preferred

Tools

ICD-10 coding and CPT

Epic

Job description

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The Prior Authorization Specialist is vital for the team and you will be serving as a liaison between the hospital, insurance companies, and patients to ensure proper coordination and reimbursement for healthcare services. You will verify insurance coverage, obtains pre-authorization for medical procedures, and facilitates timely billing and payment processes. This role also educates patients about their insurance benefits and assists in resolving any insurance-related issues or disputes.

What You'll Do

• Verify insurance coverage and eligibility for patients prior to medical procedures or hospital admissions.
• Obtain pre-authorization from insurance companies for various medical procedures, surgeries, and diagnostic tests.
• Collaborate with healthcare providers, including physicians and nurses, to ensure accurate and complete documentation for insurance claims.
• Communicate with insurance companies to resolve any coverage issues or denials, advocating for the best interests of the hospital and patients.
• Educate patients about their insurance benefits, coverage limitations, and financial responsibilities.
• Assist patients in understanding and navigating the insurance claim process, including explanation of benefits (EOB) and billing statements.
• Process and submit insurance claims accurately and in a timely manner, adhering to industry regulations and guidelines.

Qualifications

• High School Diploma or Equivalent required and Associate's Degree Related Field of Study preferred
• Epic experience, as well as referral or authorization experience in a healthcare setting highly preferred
• Previous experience in healthcare administration, insurance authorization/verification, scheduling, or medical billing 2-3 years required

Skills for Success

• In-depth knowledge of health insurance plans, including managed care, PPOs, HMOs, and Medicare/Medicaid.
• Familiarity with medical terminology, coding systems (such as ICD-10 and CPT), and healthcare billing processes.
• Strong interpersonal and communication skills to effectively interact with patients, insurance companies, and healthcare professionals.
• Detail-oriented with excellent organizational and problem-solving abilities.
• Proficient in using computer systems and software applications related to insurance verification, billing, and claims processing.
• Ability to handle sensitive and confidential information with utmost professionalism and discretion.

Additional Job Details (if applicable)

• M-F 8:30 am-5:00 pm EST schedule required for remote role
• Quiet, secure, stable, compliant work station required and will be verified at interview and day 1

Remote Type

Remote

Work Location

399 Revolution Drive

Pay Range

$21 - $28.30/Hourly

Grade

3

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

• comprehensive benefits
• career advancement opportunities
• differentials
• premiums and bonuses as applicable
• recognition programs designed to celebrate your contributions and support your professional growth

EEO Statement

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities