Prior Authorization Specialist I - Per Diem

Boston Medical Center (BMC); Boston (MA); Remote; USD 40,000 - 55,000; Part time

Job summary

A leading healthcare institution in Boston is seeking a Prior Authorization Specialist I to manage financial clearance activities. This role involves screening requests for medical services, ensuring compliance with policies, and collaborating with various stakeholders. Ideal candidates will have experience in healthcare and insurance verification, with strong communication skills and attention to detail.

Qualifications

• 4-5 years in office, healthcare, or customer service roles.
• Experience in insurance verification and authorization processes.

Responsibilities

• Screen prior-authorization and coordinate specialized services requests.
• Manage financial clearance activities such as insurance verification.
• Coordinate with providers and patients to obtain necessary authorizations.

Skills

Bilingual

Communication

Medical Terminology

Insurance Procedures

High Accuracy

Education

High School Diploma or GED

Associate’s Degree

Tools

Epic

MS Office

Job description

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Position Summary

Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including requests for inpatient, outpatient, and ancillary services. Adheres to policies and procedures to ensure performance and compliance standards are met, and healthcare delivery is cost-effective and appropriate. Maintains current knowledge of network resources for referral and linkage to members and providers. Authorizes specific services under supervision, forwards requests for clinician review, and handles provider and department calls.

Additional Responsibilities

The Prior Authorization Specialist is part of the Revenue Cycle Patient Access team, managing financial clearance activities such as pre-registration, insurance verification, referral authorization, and precertification. Ensures timely access to care and maximizes hospital reimbursement, collaborating with insurance reps, patients, physicians, and staff. This remote role reports to the Patient Access Supervisor.

Essential Duties

• Prioritize incoming requests and process them according to policies.
• Refer complex cases requiring clinical judgment to appropriate clinicians or managers.
• Meet or exceed productivity standards and handle a full caseload.
• Answer calls, verify eligibility, and document information in the system.
• Coordinate with providers and patients to obtain necessary authorizations and referrals.
• Maintain confidentiality and adhere to legal and organizational policies.
• Participate in training and quality assurance activities.

Qualifications

Education: High school diploma or GED required; Associate’s Degree preferred.

Experience: 4-5 years in office, healthcare, or customer service roles, with experience in insurance verification and authorization processes.

Skills & Abilities: Bilingual preferred, high accuracy, excellent communication, knowledge of medical terminology and insurance procedures, proficiency with Epic and MS Office.

Additional Details

Position: Prior Authorization Specialist I - Per Diem

Department: Insurance Verification

Schedule: Part-Time, Per Diem

Seniority Level: Entry level

Industry: Hospitals and Healthcare