Massachusetts General Hospital
Prior Authorization Specialist, Hybrid
Massachusetts General Hospital, Somerville, Massachusetts, us, 02145
Site: The Brigham and Women's Hospital, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job 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
Qualifications 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.
Additional Job Details (if applicable) Remote Type
Hybrid Work Location
399 Revolution Drive Pay Range
$19.42 - $27.74/Hourly Grade
3 EEO Statement
The Brigham and Women's Hospital, Inc. 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. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. #J-18808-Ljbffr
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
Qualifications 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.
Additional Job Details (if applicable) Remote Type
Hybrid Work Location
399 Revolution Drive Pay Range
$19.42 - $27.74/Hourly Grade
3 EEO Statement
The Brigham and Women's Hospital, Inc. 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. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. #J-18808-Ljbffr