Prior Authorization Specialist - Per Diem

Boston Medical Center; Boston (MA); Remote; USD 40,000 - 70,000; Part time

Job summary

Ein etabliertes Gesundheitsunternehmen sucht einen Prior Authorization Specialist, der für die Bearbeitung von Autorisierungsanfragen und die Koordination von Dienstleistungen verantwortlich ist. In dieser spannenden Rolle arbeiten Sie mit einem dynamischen Team zusammen, um sicherzustellen, dass Patienten rechtzeitig Zugang zu benötigten medizinischen Leistungen erhalten. Sie werden auch mit Versicherungsvertretern und anderen Fachleuten zusammenarbeiten, um die Qualität und Effizienz der Gesundheitsversorgung zu maximieren. Wenn Sie eine Leidenschaft für den Kundenservice und die Gesundheitsversorgung haben, ist dies die perfekte Gelegenheit für Sie.

Qualifications

• 4-5 Jahre Erfahrung in Bürosettings oder im Gesundheitswesen.
• Kenntnisse in Versicherungsüberprüfung und Autorisierungsprozessen.

Responsibilities

• Verarbeitung von Autorisierungsanfragen gemäß Richtlinien.
• Zusammenarbeit mit Ärzten und Versicherungsvertretern zur Sicherstellung von Genehmigungen.

Skills

Kundenservice

Datenverarbeitung

Versicherungsüberprüfung

Kommunikationsfähigkeiten

Multitasking

Education

High School Diplom oder GED

Associate Degree

Tools

Epic

Microsoft Office

Job description

POSITION SUMMARY:

Responsible for screening prior-authorization and coordinating specialized services requests in the medical care management program, including inpatient, outpatient, and ancillary services. Adheres to policies and procedures to ensure performance, compliance, cost-effectiveness, and appropriate healthcare delivery. Maintains current knowledge of network resources for referrals and linkage to members and providers. Authorizes specified services under supervision, forwards requests for review, and answers calls from providers and departments.

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 referrals or precertification numbers. Ensures timely access to care and maximizes hospital reimbursement, adhering to quality and productivity standards. Reports to the Patient Access Supervisor and collaborates with insurance representatives, patients, physicians, and other staff. This is a remote position.

Position: Prior Authorization Specialist - Per Diem

Department: Insurance Verification

Schedule: Part Time, Per Diem

ESSENTIAL RESPONSIBILITIES / DUTIES:

1. Prioritize incoming authorization requests.
2. Process requests, including authorizations, as per policies and procedures.
3. Refer clinical requests to clinicians or management.
4. Meet or exceed performance metrics and turnaround times.
5. Support clinicians and coordinate with members, providers, and departments.
6. Answer calls, verify eligibility, and document information.
7. Identify network providers and inform callers of benefits.
8. Coordinate resolution of escalated inquiries.
9. Promote understanding of authorization processes.
10. Maintain knowledge of member handbooks and coverage evidence.
11. Monitor and clear work queues for financial clearance.
12. Ensure compliance with insurance requirements for authorizations and referrals.
13. Navigate policies to obtain necessary approvals for scheduled care.
14. Use various strategies for insurance verification and authorization.
15. Obtain and document referrals and authorizations prior to services.
16. Collaborate with practices, physicians, and payers to ensure approvals.
17. Liaise for peer reviews when needed.
18. Escalate denied or unresolved accounts.
19. Interview patients and providers to gather necessary information.
20. Update demographic and insurance information accurately.
21. Reconcile insurance data and follow up as needed.
22. Refer unresolved cases to financial counseling.
23. Maintain confidentiality and comply with regulations.
24. Participate in training and process improvement initiatives.
25. Meet productivity and quality standards.
26. Handle calls and emails professionally, following scripts and standards.
27. Participate in quality audits and report system issues.
28. Communicate effectively with all stakeholders.
29. Attend required training sessions.
30. Assist in onboarding new personnel.
31. Perform other duties as assigned.

(This description is not exhaustive of all duties.)

Must adhere to BMC's RESPECT standards.

JOB REQUIREMENTS

Education:

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

Certificates, Licenses, and Registrations:

None required.

Experience:

• 4-5 years in office settings such as high-volume data entry, customer service, or healthcare administration.
• Experience with insurance payer websites.
• Customer service experience preferred.
• Experience with insurance verification and authorization processes.

Knowledge, Skills, & Abilities:

• Bilingual preferred.
• Ability to process high volumes with ≥95% accuracy.
• Prioritize workload effectively within turnaround times.
• Strong collaboration and communication skills.
• Thorough understanding of financial clearance processes and insurance policies.
• Knowledge of medical terminology, ICD-9/CPT coding is helpful.
• Excellent interpersonal skills and confidentiality.
• Self-directed, organized, and able to multitask.
• Decision-making under pressure, good judgment, and customer service skills.
• Experience with Epic and ancillary systems preferred.
• Proficient in Microsoft Office applications.

Equal Opportunity Employer/Disabled/Veterans