Prior Authorization Specialist, Neurology

2200 The Brigham and Women's Hospital, Inc.; Boston (MA); On-site; USD 55,000 - 75,000; Full time

Job summary

The Brigham and Women's Hospital, Inc. seeks a Prior Authorization Specialist II to support Neurology revenue cycle operations with authorizations, referrals, and eligibility verification.

You will work with providers and clinical staff to ensure timely processing of payer requirements and maintain accurate documentation within Epic. This role requires strong attention to detail, effective communication, and ability to navigate complex insurance processes while providing high-quality customer

Qualifications

• High School Diploma or Equivalent required.
• 2–3 years experience in medical authorization or related field.
• Epic experience preferred (0–1 year).

Responsibilities

• Obtain insurance authorizations prior to patient services.
• Manage referrals and verify eligibility in Epic and payer systems.
• Assist with denials, appeals, and documentation to support authorization requirements.
• Maintain accurate documentation of authorization and referral activity in Epic.
• Collaborate with providers and staff to gather necessary information for authorization requests.
• Back up other Specialists and administrative staff as needed.

Skills

Attention to detail

Communication

Medical terminology

Insurance benefits knowledge

Team collaboration

Fast-paced environment

Education

High School Diploma or Equivalent

Tools

Epic

Job description

Site

Site: The Brigham and Women's Hospital, Inc.

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 II supports the Department of Neurology's revenue cycle operations, with a primary focus on prior authorizations, referrals, insurance eligibility verification, and resolution of authorization-related denials. Working closely with providers, clinical teams, and revenue cycle staff, this role ensures timely and accurate processing of payer requirements to support patient care and reimbursement. The position is responsible for obtaining and managing authorizations, working payer denials and appeals related to authorization requirements, and helping remove barriers to care and reimbursement. The role requires strong attention to detail, effective communication skills, and the ability to navigate complex insurance and authorization processes while maintaining accurate documentation and a high level of customer service.

Qualifications

Education

High School Diploma or Equivalent required

Can this role accept experience in lieu of a degree? No

Experience in medical authorization or a related field 2-3 years required and Epic experience 0-1 year preferred

Knowledge, Skills and Abilities

• Excellent attention to detail and organizational skills.
• Strong communication and interpersonal skills.
• Knowledge of medical terminology and medical insurance benefits, including a complete understanding of the coordination of benefits.
• Familiarity with computer systems and databases.
• Ability to work independently and as part of a team.
• Ability to work in a fast-paced environment.

Authorization, Referral, and Eligibility Management

• Obtain insurance authorizations prior to initiation of patient services.
• Ensure all required insurance referrals are received, complete, and accurately documented.
• Perform demographic and insurance eligibility checks in Epic, NEHEN, and other payer systems; update or escalated discrepancies as needed.
• Facilitate referral and prior authorization requests with payers and specialty pharmacies via phone, fax, and payer portals.
• Collect, review, and submit clinical documentation required to support medical necessity and payer authorization requirements.
• Collaborate with providers and clinical staff to obtain information necessary to support authorization requests, reconsiderations, and appeals.
• Independently manage complex, high-cost, high-risk, or time-sensitive authorization requests and escalated issues as appropriate.
• Maintain accurate and timely documentation of all authorization and referral activity in Epic.

Authorization Denial & Reimbursement Support

Maintain working knowledge of payer requirements, coverage guidelines, and eligibility rules across managed care organizations. Monitor and take action on work queues related to authorizations, referrals, denials, and appeals, ensuring timely follow-up and resolution. Partner with the Lead Managed Care Coordinator, revenue cycle, and billing teams to resolve authorization- and referral-related denials and support reconsiderations, reprocessing, and appeals. Assist in identifying and escalating payer or patient-related issues that may impact reimbursement. Identify trends in authorization denials or delays and communicate opportunities for improvement to leadership.

Operational Workflow Support

Follow established department workflows and managed care processes. Scan provider schedules for non-contracted plans and escalated issues to Practice Administrators or the Lead Managed Care Coordinator. Maintain up-to-date tracking mechanisms and records of authorization, referral, denial, and appeal activities. Participate in Department Appointment Review (DAR) follow-up activities where applicable. Review payer-specific requirements, site-of-care guidelines, and coverage limitations and escalated concerns as appropriate. Collaborate with team members to review, adopt, and maintain workflows and best practices. Serve as backup to other Prior Authorization Specialists and administrative staff as needed.

Collaboration & Communication

Work closely with Practice Administrators, registration teams, billing staff, providers, and clinical teams to ensure accurate information flow. Communicate clearly with patients regarding authorization requirements, status updates, insurance-related barriers to care, and next