Remote Prior Authorization Specialist - Part-Time

Baystatehealth; United States; Remote; USD 30,000 - 47,000; Part time

Benefits offered by this job

Medical, dental, and vision coverage

Tuition assistance

Career growth opportunities

Regional opportunities across Baystate

Sign-On bonuses (external hires only)

Retirement plan

Paid time off

Job summary

Baystate Health is seeking a Prior Authorization Specialist to join the Contact Center. This remote, part-time role supports referrals and authorizations for specialty services and testing across Massachusetts and Connecticut, coordinating with providers, offices, insurers, and patients to ensure timely access to care.

You will process referrals and authorizations, monitor denials, maintain documentation, and stay current with insurance requirements.

Qualifications

• 1-3 years of medical insurance knowledge.
• Bilingual English/Spanish preferred.
• Knowledge of medical terminology preferred.
• Proficiency with Microsoft Office, Word, and Excel.
• Experience with CIS inbox and EMR.

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.
• Maintain accurate documentation in the patient's medical record and update the status of referrals and authorizations as appropriate.

Skills

Medical insurance knowledge

Bilingual English/Spanish (preferred)

Medical terminology

Microsoft Office (Word, Excel)

CIS inbox and EMR experience

Education

GED or HiSET

Job description

Baystate Health is seeking a Prior Authorization Specialist to join the Contact Center. This remote, part-time role supports referrals and authorizations for specialty services and testing across Massachusetts and Connecticut, coordinating with providers, offices, insurers, and patients to ensure timely access to care.

You will process referrals and authorizations, monitor denials, maintain documentation, and stay current with insurance requirements.