Remote Prior Authorization Specialist (Per Diem)

Baystate Health; Holyoke (MA); Remoto; USD 32.000 - 44.000; Tempo pieno

Descrizione del lavoro

Baystate Health is hiring a Prior Authorization Specialist in Holyoke, MA with remote work options for MA & CT. You will support referrals and authorizations for specialty services, working with providers, insurance companies, and patients to ensure timely access to care.

The role emphasizes accurate processing, documentation, problem solving, and independent work while collaborating with healthcare professionals to improve service delivery.

Competenze

• 1-3 years of medical insurance knowledge.

Mansioni

• 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.
• Stay current with insurance authorization requirements and communicate changes, trends, and process updates to providers and staff.

Conoscenze

Medical insurance knowledge

Formazione

GED or HiSET

Strumenti

CIS inbox

EMR

Microsoft Office (Word & Excel)

Descrizione del lavoro

Baystate Health is hiring a Prior Authorization Specialist in Holyoke, MA with remote work options for MA & CT. You will support referrals and authorizations for specialty services, working with providers, insurance companies, and patients to ensure timely access to care.

The role emphasizes accurate processing, documentation, problem solving, and independent work while collaborating with healthcare professionals to improve service delivery.