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Prior Authorization Specialist, Hybrid

3 weeks ago

Somerville, MA, United States Brigham and Women's Hospital Full time

Summary:
Responsible for reviewing and processing requests for authorization of medical services in accordance with company policies and procedures. Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging. Notifies the appropriate departments of insurance information and obtains and inputs corrected insurance information as needed.
Does this position require Patient Care? No
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.
-Research and ensure proper and accurate diagnosis and procedure codes are assigned
-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
-Code authorization status in system and complete workflow. Research and remedy denials, while escalating complex denials.
-Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed

Education
High School Diploma or Equivalent required

Can this role accept experience in lieu of a degree?
No

Licenses and Credentials

Experience
experience in medical authorization or related field 1-2 years 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 complete understanding of 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.

The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.