Remote Prior Authorization Specialist

Mass General Brigham; Somerville (MA); Remote; USD 32,000 - 46,000; Full time

Job summary

Mass General Brigham Incorporated is seeking an Insurance Authorization Specialist to review and process prior authorization and referrals, ensuring medical necessity and payer requirements are met, with HIPAA-compliant documentation.

You will collaborate with clinicians to confirm CPT codes, coordinate with patients for financial counseling when needed, and maintain accurate authorization status in the EHR. This role supports efficient patient care in a fast-paced team.

Qualifications

• High school diploma or equivalent required.
• 1-2 years medical authorization or related field experience preferred.
• Epic experience preferred.

Responsibilities

• Secure insurance authorizations within an appropriate timeframe.
• Collaborate with ordering clinicians to ensure proper CPT codes are submitted.
• Refer patients to financial counseling when appropriate.
• Inform patients of authorization concerns and coordinate with relevant departments.
• Update authorization status in the system and complete workflow.
• Respond to inquiries regarding authorization decisions and provide explanations.

Skills

Attention to detail

Communication

Medical terminology

Insurance benefits

Computer systems

Teamwork

Fast-paced environment

Education

High school diploma or equivalent

Tools

Epic

Job description

Mass General Brigham Incorporated is seeking an Insurance Authorization Specialist to review and process prior authorization and referrals, ensuring medical necessity and payer requirements are met, with HIPAA-compliant documentation.

You will collaborate with clinicians to confirm CPT codes, coordinate with patients for financial counseling when needed, and maintain accurate authorization status in the EHR. This role supports efficient patient care in a fast-paced team.