Massachusetts General Hospital
Prior Authorization Specialist
Massachusetts General Hospital, Somerville, Massachusetts, United States, 02143
Medical Services Authorization Reviewer
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. 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 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. Physical Requirements: Standing Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote Type: Hybrid Work Location: 399 Revolution Drive Scheduled Weekly Hours: 40 Employee Type: Regular Work Shift: Day (United States of America) 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.
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. 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 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. Physical Requirements: Standing Occasionally (3-33%) Walking Occasionally (3-33%) Sitting Constantly (67-100%) Lifting Occasionally (3-33%) 20lbs - 35lbs Carrying Occasionally (3-33%) 20lbs - 35lbs Pushing Rarely (Less than 2%) Pulling Rarely (Less than 2%) Climbing Rarely (Less than 2%) Balancing Occasionally (3-33%) Stooping Occasionally (3-33%) Kneeling Rarely (Less than 2%) Crouching Rarely (Less than 2%) Crawling Rarely (Less than 2%) Reaching Occasionally (3-33%) Gross Manipulation (Handling) Constantly (67-100%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote Type: Hybrid Work Location: 399 Revolution Drive Scheduled Weekly Hours: 40 Employee Type: Regular Work Shift: Day (United States of America) 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.