[Hiring] Prior Authorization Specialist @Mass General Brigham

Role Description

Performs advanced prior authorization and referral activities, including complex and high-risk cases. Serves as a subject-matter expert and escalation resource for peers while maintaining an individual workload. Ensures insurance eligibility, coordination of benefits, site‑of‑care compliance, and medical necessity by gathering and submitting complete medical documentation in alignment with HIPAA standards. Accurately documents authorization outcomes and all payer communications in the electronic health record.

• Work as part of a group to secure insurance authorizations in an appropriate timeframe.
• Collects and accurately enters information required by third parties for precertification for procedures, tests, and imaging.
• When unclear, collaborates with ordering clinicians to ensure the proper CPT codes are submitted for prior authorization or referrals.
• Refer patients to financial counseling, as appropriate.
• Inform patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, collaborating with other departments/offices to resolve complex authorization issues.
• Independently manages complex, high-dollar, or time-sensitive authorization cases prior to escalation to leadership.
• Assists with onboarding and informal training of new staff and provides peer quality review as assigned.
• Identifies denial or delay trends and elevates improvement opportunities to leadership.

Qualifications

• High School Diploma or Equivalent required.
• Experience in medical authorization or a related field: 2-3 years required.
• Epic experience: 0-1 year preferred.
• Excellent attention to detail and organizational skills.
• Strong communication and interpersonal skills.
• Knowledge of medical terminology and medical insurance benefits, including a complete understanding of the coordination of benefits.
• Familiarity with computer systems and databases.
• Ability to work independently and as part of a team.
• Ability to work in a fast-paced environment.

Requirements

• This is a fully remote part-time position.
• Schedule is Monday - Friday. The shift will be 5, 6 hour shifts, for a total of 30 hours/week.
• This is a benefits eligible role.
• Employee Type: Regular.
• Work Shift: Day (United States of America).
• Pay Range: $22.22 - $31.71/Hourly.
• Grade: 4.

Benefits

• Comprehensive benefits.
• Career advancement opportunities.
• Differentials, premiums, and bonuses as applicable.
• Recognition programs designed to celebrate your contributions and support your professional growth.