Remote Prior Authorization Specialist (Healthcare)

Baystate Health; Holyoke (MA); Remote; USD 32,000 - 44,000; Full time

Job summary

Baystate Health is seeking a Prior Authorization Specialist to join our Contact Center. This fully remote role supports referrals and authorizations for specialty services and testing across Massachusetts and Connecticut, working closely with providers, insurance companies, and patients to ensure timely access to care.

The role involves processing referrals, monitoring denials, and maintaining accurate documentation while staying current with changing authorization requirements.

Qualifications

• 1-3 years of medical insurance knowledge.
• Proficiency with Microsoft Office (Word and Excel).
• Experience with CIS inbox and EMR 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.

Skills

Medical insurance knowledge

Education

GED/HiSET

Tools

Microsoft Office (Word)

Microsoft Excel

CIS inbox

EMR

Job description

Baystate Health is seeking a Prior Authorization Specialist to join our Contact Center. This fully remote role supports referrals and authorizations for specialty services and testing across Massachusetts and Connecticut, working closely with providers, insurance companies, and patients to ensure timely access to care.

The role involves processing referrals, monitoring denials, and maintaining accurate documentation while staying current with changing authorization requirements.