Prior Authorization Specialist, Insurance Verification
New
B
Boston Medical CenterHealthcare
United StatesPart-TimeMiddle
Salary25.8 - 31.43 USD per year
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Job Details
- Experience
- 4-5 years of office experience, specifically in either a high volume data entry office, customer service call center or health care office or hospital administration is required.
- Required Skills
- Microsoft Excel
Requirements
- High school diploma or GED required; an associate’s degree or higher is preferred.
- 4-5 years of office experience in high-volume data entry, a customer service call center, or healthcare office or hospital administration required.
- Experience using insurance payer websites, such as Blue Cross Blue Shield or Medicare, required.
- Experience with insurance verification, prior authorization, precertification, and financial clearance processes required.
- Ability to process high volumes of requests with at least 95% accuracy.
- Ability to prioritize referrals and authorization requests within specified turnaround timeframes.
- Thorough knowledge of the financial clearance process, insurance, referral authorizations, and third-party billing procedures.
- Epic experience is preferred; technical proficiency in Epic work queues and applicable ancillary systems is required.
- Basic computer proficiency, including Microsoft Excel, Word, Outlook, and Zoom.
- Knowledge of basic medical terminology and ICD-9/CPT coding is helpful.
- Ability to maintain confidentiality of personal and health-sensitive information.
Responsibilities
- Prioritize and process incoming prior authorization requests according to departmental policies and workflows.
- Refer requests requiring clinical judgment to the Prior Authorization Clinician, Manager, or Medical Director.
- Verify member eligibility, communicate decisions, and answer provider and department calls.
- Monitor registration and authorization work queues and obtain required patient and payer financial-clearance information.
- Obtain and document referrals, prior authorizations, and precertifications in Epic and relevant practice management systems.
- Coordinate with patients, providers, practices, insurance carriers, and departments to secure approvals before scheduled services.
- Review and update demographic and insurance information, validating coverage and related details with carriers.
- Escalate denied or uncleared accounts and refer self-pay or unresolved insurance cases to Patient Financial Counseling.
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