Job 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.

Qualifications

Education

High School Diploma or Equivalent required

Experience

Medical authorization or related field experience 1-2 years preferred and 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

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

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$19.81 - $28.30/Hourly

Grade

3

EEO Statement

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.