Authorization Specialist

4 weeks ago


Newton, Massachusetts, United States Mass General Brigham Full time
Job Summary: As a Preauthorization Specialist at Mass General Brigham, you will play a critical role in ensuring timely and accurate financial reimbursement for patient care. Under the direction of the Financial Coordinator Supervisor, you will analyze and submit necessary information to insurance companies for approval prior to the patient's date of service. Your collaboration with insurance companies and physician offices will be essential in verifying eligibility and authorization requirements.

Key Responsibilities:

* Perform insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third-party payers.
* Ensure all possible coverages are created and verified, through electronic or manual methods, and all discrepancies are resolved.
* Collect and validate order-related information, including office visit, radiology, and surgical orders.
* Escalate challenging accounts to team lead to ensure accounts are approved prior to patient appointment/surgery.
* Work closely with physician offices to obtain authorization for inpatient and outpatient services.

Qualifications:

* High school graduate or equivalent; some college preferred.
* 1-2 years of insurance, third-party payor, or secretarial experience in a healthcare setting required.
* Medical Terminology required.
* Analytical ability to gather and interpret data and communicate desired outcomes orally and in writing in a professional manner.
* Strong communication and interpersonal skills.
* Ability to handle multiple duties.

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