Remote Prior Authorization Specialist - Financial Clearance

Boston Medical Center; United States; Remote; USD 45,000 - 65,000; Full time

Job summary

Boston Medical Center is seeking a dedicated Prior Authorization Specialist to screen pre-authorizations and coordinate referrals for inpatient, outpatient, and ancillary services in a remote capacity. This role supports timely access to care by navigating pre-registration, insurance verification, and referrals within Epic and payer portals.

The specialist collaborates with physicians, care teams, and insurance representatives to obtain necessary approvals, while ensuring compliance and accurate

Qualifications

• Education: High school diploma or GED required. Associate’s Degree or higher preferred.
• Experience: 4-5 years of office experience in high-volume data entry, customer service, or health care administration.
• KSAs: Bilingual preferred.
• Ability to process high volume of requests with accuracy and meet turnaround times.

Responsibilities

• Prioritize incoming Prior Authorization requests.
• Process requests, including authorizing services per policies.
• Refer complex cases to clinicians or manager.
• Maintain productivity and quality metrics.
• Verify member eligibility and enter data for requests in the systems.

Skills

Customer service

Communication

Multitasking

Data entry

Education

High school diploma or GED

Associate’s Degree or higher (preferred)

Tools

Epic System

ADT/Prelude/Grand Centrale

Job description

Boston Medical Center is seeking a dedicated Prior Authorization Specialist to screen pre-authorizations and coordinate referrals for inpatient, outpatient, and ancillary services in a remote capacity. This role supports timely access to care by navigating pre-registration, insurance verification, and referrals within Epic and payer portals.

The specialist collaborates with physicians, care teams, and insurance representatives to obtain necessary approvals, while ensuring compliance and accurate