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

The Prior Authorization Specialist is vital for the team and you will be serving as a liaison between the hospital, insurance companies, and patients to ensure proper coordination and reimbursement for healthcare services.

You will verify insurance coverage, obtains pre-authorization for medical procedures, and facilitates timely billing and payment processes. This role also educates patients about their insurance benefits and assists in resolving any insurance-related issues or disputes.

What You'll Do

-Verify insurance coverage and eligibility for patients prior to medical procedures or hospital admissions.
-Obtain pre-authorization from insurance companies for various medical procedures, surgeries, and diagnostic tests.
-Collaborate with healthcare providers, including physicians and nurses, to ensure accurate and complete documentation for insurance claims.
-Communicate with insurance companies to resolve any coverage issues or denials, advocating for the best interests of the hospital and patients.
-Educate patients about their insurance benefits, coverage limitations, and financial responsibilities.
-Assist patients in understanding and navigating the insurance claim process, including explanation of benefits (EOB) and billing statements.
-Process and submit insurance claims accurately and in a timely manner, adhering to industry regulations and guidelines.

Qualifications

• High School Diploma or Equivalent required and Associate's Degree Related Field of Study preferred
• Epic experience, as well as referral or authorization experience in a healthcare setting highly preferred
• Previous experience in healthcare administration, insurance authorization/verification, scheduling, or medical billing 2-3 years required

Skills for Success

• -In-depth knowledge of health insurance plans, including managed care, PPOs, HMOs, and Medicare/Medicaid.
• Familiarity with medical terminology, coding systems (such as ICD-10 and CPT), and healthcare billing processes.
• Strong interpersonal and communication skills to effectively interact with patients, insurance companies, and healthcare professionals.
• Detail-oriented with excellent organizational and problem-solving abilities.
• Proficient in using computer systems and software applications related to insurance verification, billing, and claims processing.
• Ability to handle sensitive and confidential information with utmost professionalism and discretion.

Additional Job Details (if applicable)

• M-F 8:30 am-5:00 pm EST schedule required for remote role
• Quiet, secure, stable, compliant work station required and will be verified at interview and day 1

Remote Type

Remote

Work Location

399 Revolution Drive

Pay Range

$21 - $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.

EEO Statement:

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

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.