Prior Authorization Specialist

This is a fully remote position, open to applicants in Connecticut, +1 more state.

📋 Description

• Handle referrals and prior authorizations for specialized services and testing.

• Work collaboratively with clinical team members, physician offices, agencies, and insurance providers to gather necessary information.

• Keep track of denial and no-referral reports.

• Acquire required authorizations and referrals.

• Process appeals for any denied claims.

• Oversee and maintain the Electronic Referral Tracking Report.

• Prioritize requests according to urgency and established criteria.

• Offer guidance and support regarding referral and authorization inquiries and processing challenges.

• Communicate authorization decisions and timely updates to providers, staff, patients, and families.

• Ensure accurate documentation in patients' medical records.

• Update statuses for referrals and authorizations.

• Stay informed about insurance authorization requirements and relay any changes, trends, and process updates.

⛳️ Requirements

• 1-3 years of experience in medical insurance.

• Proficiency in Microsoft Office, including Word and Excel.

• Familiarity with CIS inbox and EMR systems.

• GED or HiSET is required.

• Bilingual in English and Spanish is preferred.

• Knowledge of medical terminology is preferred.

🏝️ Benefits

• Medical, dental, and vision coverage, including local Health New England plans (subject to eligibility).

• Tuition assistance available.

• Continuing education units (CEUs).

• Opportunities for professional development.

• Potential for clinical advancement.

• Leadership development programs.

• Internal career opportunities.

• Career options throughout Baystate Health hospitals, practices, and services across western Massachusetts.

• Retirement savings plan with employer matching (depending on eligibility).