Prior Authorization Specialist - Per Diem

Boston Medical Center Health System; Boston (MA); On-site; USD 40,000 - 65,000; Part time

Job summary

An established industry player is seeking a dedicated Prior Authorization Specialist to join their Revenue Cycle Patient Access team. This part-time, per diem role focuses on ensuring timely access to care while maximizing hospital reimbursement. The ideal candidate will have a strong background in customer service and experience with insurance verification processes. You will be responsible for processing authorization requests, collaborating with various stakeholders, and maintaining compliance with insurance requirements. If you're passionate about healthcare and have the skills to thrive in a fast-paced environment, this opportunity is perfect for you.

Qualifications

• 4-5 Jahre Erfahrung in Büroarbeit, bevorzugt im Gesundheitswesen.
• Kenntnisse in Versicherungsüberprüfung und finanzieller Freigabe.

Responsibilities

• Verarbeitung und Priorisierung eingehender Anfragen zur Prior Genehmigung.
• Zusammenarbeit mit Versicherungsvertretern und internen Abteilungen.

Skills

Datenverarbeitung

Kundenservice

Versicherungsüberprüfung

Prior Authorization

Zeitmanagement

Kommunikationsfähigkeiten

Education

High School Diploma oder GED

Associate Degree oder höher

Tools

Epic

Microsoft Office

Zoom

Job description

POSITION SUMMARY:

Responsible for screening prior-authorization requests and coordinating specialized services in the medical care management program, including inpatient, outpatient, and ancillary services. Ensures compliance with policies and procedures to meet performance and compliance standards, promoting cost-effective healthcare delivery. Maintains current knowledge of network resources for referrals and linkages. Authorizes specific services under supervision, forwards requests to clinicians for review, and handles provider inquiries via ACD lines.

The Prior Authorization Specialist is part of the Revenue Cycle Patient Access team, managing financial clearance activities such as pre-registration, insurance verification, and obtaining referral or precertification numbers. The role ensures timely access to care and maximizes hospital reimbursement, adhering to quality and productivity standards. It involves collaboration with insurance representatives, patients, providers, and internal departments. This is a remote, part-time, per diem position.

Position: Prior Authorization Specialist - Per Diem

Department: Insurance Verification

Schedule: Part Time, Per Diem

ESSENTIAL RESPONSIBILITIES / DUTIES:

1. Prioritize and process incoming Prior Authorization requests, including authorizations for specified services.
2. Refer complex requests requiring clinical judgment to clinicians or management.
3. Meet or exceed metrics and turnaround times while managing full caseloads.
4. Support clinicians and verify member eligibility via ACD calls, entering data into CCMS or Facets.
5. Inform callers about network providers, services, and benefits.
6. Coordinate resolution of escalated inquiries from members or providers.
7. Educate members and providers about Prior Authorization procedures and requirements.
8. Maintain understanding of member handbooks and coverage evidence.
9. Monitor and clear work queues by obtaining necessary financial clearance elements.
10. Ensure compliance with insurance requirements for prior authorizations and referrals.
11. Navigate payer policies to secure approvals for scheduled care, assisting clinicians with payer requirements.
12. Use various strategies and tools (online databases, electronic correspondence, faxes, calls) for verification and authorization.
13. Document all referral and authorization information accurately within Epic prior to services.
14. Collaborate with practices, physicians, insurance carriers, and patients to obtain and record necessary approvals, linking approval numbers to appointments.
15. Coordinate with patients, providers, and departments to gather required information and permissions before scheduled services.
16. Liaise for peer-to-peer reviews when needed and escalate denied accounts as per policy.
17. Interview patients, families, or physicians to collect demographic and financial information for reimbursement and compliance.
18. Update and verify insurance and demographic data, contacting patients as needed for clarifications.
19. Refer unresolved or self-pay patients to Financial Counseling.
20. Maintain confidentiality of all patient information, adhering to legal and organizational policies.
21. Participate in training and process improvement initiatives, meeting productivity and quality standards.
22. Handle calls and emails promptly, following customer service standards.
23. Report system issues to IT and notify management of unresolved problems.
24. Communicate effectively and courteously with all stakeholders.
25. Attend training and assist in onboarding new personnel.
26. Perform additional duties as assigned.

JOB REQUIREMENTS

Education:

• High school diploma or GED required; Associate’s Degree or higher preferred.

Certificates, Licenses, Registrations:

None required.

Experience:

• 4-5 years of office experience, preferably in high-volume data entry, customer service, or healthcare administration.
• Experience with insurance payer websites (e.g., Blue Cross Blue Shield, Medicare).
• Customer service experience preferred.
• Experience with insurance verification, prior authorization, and financial clearance processes.

Knowledge, Skills & Abilities:

• Bilingual skills preferred.
• Ability to process high volumes with ≥95% accuracy.
• Prioritization and time management skills.
• Strong communication and interpersonal skills.
• Thorough knowledge of financial clearance and insurance processes.
• Familiarity with medical terminology and coding (ICD-9/CPT) is helpful.
• Proficiency with Epic and ancillary systems, Microsoft Office, and Zoom.
• Ability to handle sensitive information confidentially and work effectively under pressure.

Equal Opportunity Employer/Disabled/Veterans