Remote Medical Authorization Specialist

Talentify; Somerville (MA); Remote; USD 30,000 - 39,000; Full time

Job summary

Mass General Brigham Incorporated is seeking a dedicated professional to review and process prior authorizations and referrals for medical services in accordance with payer requirements and HIPAA standards.

You will document authorization outcomes and payer communications in the electronic health record, collaborating with clinicians as needed, and ensuring timely processing in a remote setting.

Qualifications

• 1–2 years of medical authorization or related field experience.
• Epic experience preferred.
• HIPAA knowledge and compliance.
• Ability to work in a fast-paced environment.

Responsibilities

• Work as part of a group to secure insurance authorizations in an appropriate timeframe.
• Collaborates with ordering clinicians to ensure proper CPT codes are submitted for prior authorization or referrals.
• Refer patients to financial counseling.
• 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.
• Update authorization status in system and complete workflow.
• Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed.

Skills

Attention to detail

Communication

Medical terminology

Insurance knowledge

Computer systems

Education

High School Diploma or Equivalent

Tools

Epic

Job description

Mass General Brigham Incorporated is seeking a dedicated professional to review and process prior authorizations and referrals for medical services in accordance with payer requirements and HIPAA standards.

You will document authorization outcomes and payer communications in the electronic health record, collaborating with clinicians as needed, and ensuring timely processing in a remote setting.