[Hiring] Prior Authorization Specialist @Mass General Brigham

Role Description

Reviews and processes prior authorization and referral requests for medical services in accordance with organizational policies and payer requirements. 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.
• Update authorization status in system and complete workflow.
• Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed.

Qualifications

• High School Diploma or Equivalent required
• Medical authorization or related field experience 1-2 years preferred
• 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

• M-F 8:30 AM- 5 PM EST schedule required for remote role
• A quiet, secure, stable, HIPAA-compliant workstation is required.

Benefits

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

Company Description

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.