Prior Authorization Specialist, Part Time

Mass General Brigham; Somerville (MA); Remote; USD 31,000 - 44,000; Part time

Benefits offered by this job

Fully remote

Part-time

Job summary

Mass General Brigham is seeking a remote, part-time Prior Authorization Specialist to perform advanced authorization and referral activities. You will verify insurance eligibility, coordinate benefits, and ensure medical necessity by gathering documentation in line with HIPAA standards.

This role involves high-dollar, time-sensitive cases, collaboration with clinicians, and accurate payer communication in the electronic health record.

Qualifications

• High School Diploma or equivalent required.
• 2–3 years experience in medical authorization or related field.
• Epic experience preferred.
• Excellent attention to detail and organizational skills.

Responsibilities

• Process advanced prior authorizations and referrals in a timely manner.
• Gather and submit complete medical documentation to support authorization and medical necessity.
• Collaborate with ordering clinicians to ensure proper CPT codes are used.
• Escalate complex issues to leadership and provide peer training as needed.
• Document outcomes and payer communications in the EHR.

Skills

Attention to detail

Communication skills

Medical terminology knowledge

Insurance benefits knowledge

Independent work

Team collaboration

Fast-paced environment

Education

High School Diploma or equivalent

Tools

Epic

Job description

Site: Mass General Brigham IncorporatedMass 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 SummarySummary:-Performs advanced prior authorization and referral activities, including complex and high-risk cases. Serves as a subject-matter expert and escalation resource for peers while maintaining an individual workload. Ensures insurance eligibility, coordination of benefits, site‑of‑care compliance, and medical necessity by gathering and submitting complete medical documentation in alignment with HIPAA standards. Accurately documents authorization outcomes and all payer communications in the electronic health record.Does this position require Patient Care? NoEssential Functions:-Work as part of a group to secure insurance authorizations in an appropriate timeframe. Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.-When unclear, collaborates with ordering clinicians to ensure the proper CPT codes are submitted for prior authorization or referrals.-Refer patients to financial counseling, as appropriate-Inform patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, collaborating with other departments/offices to resolve complex authorization issues-Independently manages complex, high-dollar, or time-sensitive authorization cases prior to escalation to leadership.-Assists with onboarding and informal training of new staff and provides peer quality review as assigned.-Identifies denial or delay trends and elevates improvement opportunities to leadership.QualificationsEducationHigh School Diploma or Equivalent requiredCan this role accept experience in lieu of a degree?NoExperience in medical authorization or a related field 2-3 years required and Epic experience 0-1 year preferredKnowledge, 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.Additional Job Details (if applicable)This is a fully remote part time position.Schedule is Monday- Friday. The shift will be 5, 6 hour shifts, for a total of 30 hours/week.This is a benefits eligible role.Remote TypeRemoteWork Location399 Revolution DriveScheduled Weekly Hours30Employee TypeRegularWork ShiftDay (United States of America)Pay Range$22.22 - $31.71/HourlyGrade4At 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. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.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 Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.