Prior Authorization Specialist

Site: Mass General Brigham Incorporated

 

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.

 

Job Summary

Summary

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.

Essential Functions

-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.

 

Education

• High School Diploma or Equivalent required

Experience

• Medical authorization or related field experience 1-2 years preferred
• Epic experience 0-1 year preferred

Knowledge, Skills and Abilities

• - 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.

 

Additional Job Details (if applicable)

Remote Model Requirements

• Remote
• M-F Eastern business hours required
• Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.

 

Remote

 

399 Revolution Drive

 

40

 

Regular

 

Day (United States of America)

 

Pay Range

$ - $28.30/Hourly

 

 

Grade

3

 

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

 

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

 

Mass General Brigham Competency Framework