Remote Prior Authorization Specialist

Mass General Brigham; Somerville (MA); On-site; USD 79,901,000 - 90,922,000; Full time

Job summary

Mass General Brigham is seeking a detail-oriented authorization specialist to review and process prior authorization and referrals for medical services in line with payer requirements. The role ensures eligibility, COB coordination, site-of-care compliance, and medical necessity by collecting and submitting complete documentation within HIPAA standards.

Key duties include ensuring timely CPT codes, coordinating with clinicians, and updating statuses in the electronic health record.

Qualifications

• High School Diploma or Equivalent required.
• 1-2 years medical authorization or related field experience preferred.
• Epic experience 0-1 year preferred.

Responsibilities

• Secure insurance authorizations for procedures, tests and imaging in a timely manner.
• Collaborate with ordering clinicians to ensure proper CPT codes for authorization or referrals.
• Refer patients to financial counseling when appropriate.
• Inform patients about authorization concerns prior to admission or procedure and coordinate with relevant parties.
• Update authorization status in the system and complete workflows.
• Respond to inquiries regarding authorization decisions and provide explanations as needed.

Skills

Attention to detail

Communication

Medical terminology

Insurance knowledge

Computers & databases

Teamwork

Education

High School Diploma or Equivalent

Tools

Epic

Job description

Mass General Brigham is seeking a detail-oriented authorization specialist to review and process prior authorization and referrals for medical services in line with payer requirements. The role ensures eligibility, COB coordination, site-of-care compliance, and medical necessity by collecting and submitting complete documentation within HIPAA standards.

Key duties include ensuring timely CPT codes, coordinating with clinicians, and updating statuses in the electronic health record.