Prior Authorization Specialist - Per Diem

Boston Medical Center (BMC); Boston (MA); Remote; USD 40,000 - 60,000; Part time

Job summary

A leading healthcare provider in Boston is seeking a Prior Authorization Specialist to manage screening and coordination of service requests. This remote, part-time role involves ensuring compliance with healthcare delivery standards and collaborating with various stakeholders. The ideal candidate will have relevant experience and strong communication skills, contributing to timely access to care and maximizing hospital reimbursement.

Qualifications

• 4-5 years of relevant office or healthcare experience.
• Experience with insurance websites and verification processes.

Responsibilities

• Process requests, including authorizations, as per policies.
• Coordinate resolution of escalated inquiries.
• Maintain confidentiality and comply with regulations.

Skills

Customer Service

Communication

Organizational Skills

Bilingual Skills

Education

High school diploma or GED

Associate’s degree

Tools

Epic

Microsoft 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 and to promote cost-effective and appropriate healthcare delivery. Maintains current knowledge of network resources for referral and linkage to members and providers. Authorizes certain specified services under supervision, following departmental guidelines. Forwards requests to clinicians for review and processing as per workflow. Answers ACD line calls from providers and other departments, redirecting as needed.

Additional Responsibilities

The Prior Authorization Specialist is part of the Revenue Cycle Patient Access team, responsible for coordinating financial clearance activities such as pre-registration, insurance verification, obtaining referrals, and precertification numbers. Ensures timely access to care and maximizes hospital reimbursement, adhering to quality and productivity standards. Collaborates with insurance representatives, patients, physicians, and staff. This is a remote position.

Position Details

Position: Prior Authorization Specialist - Per Diem

Department: Insurance Verification

Schedule: Part Time, Per Diem

Essential Responsibilities

1. Prioritize incoming requests.
2. Process requests, including authorizations, as per policies.
3. Refer clinical requests requiring judgment to clinicians or management.
4. Meet or exceed performance metrics and TATs.
5. Support clinicians.
6. Answer calls, verify eligibility, and document information.
7. Inform callers of providers, services, and benefits.
8. Coordinate resolution of escalated inquiries.
9. Promote understanding of authorization requirements.
10. Maintain knowledge of member handbooks and coverage.
11. Monitor work queues and obtain necessary clearance elements.
12. Navigate payer and hospital policies for approvals.
13. Use databases and communication tools for verification and authorization.
14. Obtain and document authorizations prior to services.
15. Collaborate with providers and patients to secure necessary approvals.
16. Escalate denied accounts as per policy.
17. Interview patients and providers to gather information.
18. Ensure accurate demographic and insurance data entry.
19. Refer unresolved cases to financial counseling.
20. Maintain confidentiality and comply with regulations.
21. Participate in training and process improvements.
22. Handle calls and emails promptly, following standards.
23. Participate in quality audits.
24. Report technical issues to IT.
25. Communicate effectively with all stakeholders.
26. Assist in onboarding new staff.
27. Perform other duties as assigned.

Qualifications

• High school diploma or GED required; Associate’s degree preferred.
• 4-5 years of relevant office or healthcare experience.
• Experience with insurance websites and verification processes.
• Customer service experience preferred.
• Knowledge of medical terminology and coding helpful.
• Strong communication and organizational skills.
• Ability to process high volume requests accurately.
• Bilingual skills preferred.
• Proficiency in Epic and Microsoft Office applications.

Additional Details

• Entry level, part-time, remote position.
• Equal Opportunity Employer.