Remote Prior Authorization Specialist

Mass General Brigham; United States; Remote; USD 27,000 - 39,000; Full time

Job summary

Mass General Brigham is seeking a detail-oriented Authorization Specialist to review and process prior authorization and referral requests in line with payer requirements and HIPAA standards. The role ensures eligibility, benefits coordination, site-of-care compliance, and accurate documentation in the EHR.

Responsibilities include collaborating with clinicians for CPT coding, guiding patients to financial counseling when needed, and maintaining timely authorization communication and status

Qualifications

• High School Diploma or equivalent required.
• Medical authorization or related field experience 1–2 years preferred; Epic experience 0–1 year preferred.
• Knowledge of medical terminology and medical insurance benefits; COBA/coordination of benefits understanding beneficial.

Responsibilities

• Secure insurance authorizations and precertifications within the required timeframe.
• Collaborate with ordering clinicians to ensure proper CPT codes for authorizations.
• Refer patients to financial counseling as appropriate.
• Inform patients of authorization concerns prior to admission or procedure and coordinate with stakeholders.
• Update authorization status in the system and complete workflow.
• Respond to inquiries regarding authorization decisions and provide explanations as needed.

Skills

Attention to detail

Strong communication

Medical terminology

Insurance benefits

Team collaboration

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 referral requests in line with payer requirements and HIPAA standards. The role ensures eligibility, benefits coordination, site-of-care compliance, and accurate documentation in the EHR.

Responsibilities include collaborating with clinicians for CPT coding, guiding patients to financial counseling when needed, and maintaining timely authorization communication and status