Remote Prior Authorization Specialist I

bmc; United States; Remote; USD 25,000 - 39,000; Part time

Job summary

Boston Medical Center is seeking a Remote Part-Time Prior Authorization Specialist I to screen and coordinate prior authorizations and financial clearance for inpatient, outpatient, and ancillary services. You will work with providers, patients, and internal teams to ensure timely access and compliant processes.

Responsibilities include reviewing requests, obtaining authorizations, verifying eligibility, and guiding callers through network benefits while meeting productivity standards.

Responsibilities

• Prioritizes incoming Prior Authorization requests.
• Processes incoming requests, including authorizing specified services per policies.
• Refs authorization requests requiring clinical judgment to clinician/manager/director.
• Meets or exceeds metrics and turnaround timeframes with full caseload.
• Supports Prior Authorization Clinicians.
• Answers ACD line calls, verifies member eligibility and enters information into CCMS or Facets.
• Informs callers of network providers, services and member benefits.
• Informs provider of decision per department procedure.
• Coordinates resolution of escalated member/provider inquiries related to Prior Authorization.
• Works with members, providers and departments to promote understanding of requirements.
• Maintains knowledge of member handbooks and evidence of coverage.
• Monitors queues and clears them by obtaining required financial clearance elements.

Job description

Boston Medical Center is seeking a Remote Part-Time Prior Authorization Specialist I to screen and coordinate prior authorizations and financial clearance for inpatient, outpatient, and ancillary services. You will work with providers, patients, and internal teams to ensure timely access and compliant processes.

Responsibilities include reviewing requests, obtaining authorizations, verifying eligibility, and guiding callers through network benefits while meeting productivity standards.