Remote Per Diem Prior Authorization Specialist

Baystate Health; United States; Remote; USD 32,000 - 44,000; Part time

Benefits offered by this job

Medical, dental and vision coverage

Tuition assistance and CEUs

Career growth opportunities

Regional opportunities across Baystate

Job summary

Baystate Health is seeking a Prior Authorization Specialist to support referrals and authorizations for specialty services across our remote team serving Massachusetts and Connecticut. You will work with providers, insurance companies, and patients to ensure timely access to care.

This per diem, dayshift role emphasizes accurate documentation, prompt updates, and collaboration with clinical staff. Ideal candidates have medical insurance knowledge and strong communication skills, with bilingual

Qualifications

• 1-3 years of medical insurance knowledge.
• Bilingual in English/Spanish preferred.
• Knowledge of medical terminology preferred.

Responsibilities

• Process referrals and prior authorizations for specialty services and testing, ensuring requests are accurate, timely, and properly documented.
• Collaborate with clinical team members, physician offices, agencies, and insurance companies to obtain the information needed to complete referrals and authorizations.
• Monitor denial and no-referral reports, obtain required authorizations and referrals, and process appeals for denied claims.
• Manage and maintain the Electronic Referral Tracking Report, ensuring information is accurate and requests are prioritized based on urgency and designated criteria.
• Serve as a resource for internal and external customers by providing guidance and support related to referral and authorization questions and processing issues.
• Communicate authorization decisions and provide timely updates to referring providers, ordering providers, staff, patients, and families.
• Maintain accurate documentation in the patient’s medical record and update the status of referrals and authorizations as appropriate.
• Stay current with insurance authorization requirements and communicate changes, trends, and process updates to providers and staff.

Skills

Medical insurance knowledge

Bilingual in English/Spanish

Knowledge of medical terminology

Education

GED or HiSET (Required)

Tools

Microsoft Word

Microsoft Excel

CIS inbox

EMR

Job description

Baystate Health is seeking a Prior Authorization Specialist to support referrals and authorizations for specialty services across our remote team serving Massachusetts and Connecticut. You will work with providers, insurance companies, and patients to ensure timely access to care.

This per diem, dayshift role emphasizes accurate documentation, prompt updates, and collaboration with clinical staff. Ideal candidates have medical insurance knowledge and strong communication skills, with bilingual