Remote Part-Time Prior Authorization Specialist

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

Benefits offered by this job

Remote work

Benefits eligible

Job summary

Mass General Brigham Incorporated is seeking a Prior Authorization Specialist for a fully remote, part-time role based in Massachusetts. The position entails managing advanced prior authorizations, ensuring medical necessity documentation, and coordinating benefits.

Schedule is Monday–Friday with 30 hours per week. Epic experience is preferred and prior authorization experience is required. This role includes benefits eligibility and remote work flexibility.

Qualifications

• 2-3 years experience in medical authorization or related field.
• Epic experience 0-1 year preferred.
• Excellent attention to detail and strong communication skills.

Responsibilities

• Performs advanced prior authorization and referral activities, including complex and high-risk cases.
• Serves as 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.
• Work as part of a group to secure insurance authorizations in a timely manner.
• Collaborates with ordering clinicians to ensure proper CPT codes are submitted for prior authorization or referrals.
• Refer patients to financial counseling when appropriate.
• Inform patients of authorization concerns prior to admission/procedure and coordinate with appropriate parties to facilitate authorization.
• Independently manages complex, high-dollar, or time-sensitive authorization cases prior to escalation to leadership.
• Assist with onboarding and informal training of new staff and provide peer quality review as assigned.
• Identify denial or delay trends and elevate improvement opportunities to leadership.

Education

High School Diploma or Equivalent

Job description

Mass General Brigham Incorporated is seeking a Prior Authorization Specialist for a fully remote, part-time role based in Massachusetts. The position entails managing advanced prior authorizations, ensuring medical necessity documentation, and coordinating benefits.

Schedule is Monday–Friday with 30 hours per week. Epic experience is preferred and prior authorization experience is required. This role includes benefits eligibility and remote work flexibility.