[Hiring] Prior Authorization Specialist @BMC Company 100

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad range of requests for inpatient, outpatient and ancillary services. • Adheres to policies and procedures to comply with performance and compliance standards. • Maintains current knowledge of network resources for referral and linkage to member’s and provider’s needs. • Authorizes certain specified services under the supervision of the manager according to departmental guidelines. • Forwards specified requests to the clinician for review and processing. • Answers ACD line calls from providers and other departments and redirects as needed. • Coordinates all financial clearance activities by navigating pre-registration, obtaining referral authorization, or precertification number(s). • Ensures timely access to care while maximizing BMC hospital reimbursement. • Requires adherence to quality assurance guidelines and established productivity standards. • Reports to the Patient Access Supervisor and interacts with stakeholders in the financial clearance process. Qualifications • High school diploma or GED required; Associate’s Degree or higher preferred. • 4-5 years of office experience in a high volume data entry office, customer service call center, or healthcare office. • Experience using Insurance payer websites (e.g., Blue Cross Blue Shield, Medicare). • Customer service experience preferred. • Experience with insurance verification, prior authorization, pre-certification, and financial clearance process. Requirements • Bilingual preferred. • Ability to process a high volume of requests with a 95% or greater accuracy rate. • Ability to prioritize workload when processing referrals and authorization requests per guidelines. • Effective collaboration skills. • Strong oral and written communication skills. • Thorough knowledge of financial clearance process is a must. • Familiarity with insurances, referral authorizations, and third party billing procedures. • Knowledge of basic medical terminology and ICD-9/CPT coding is helpful. • Excellent interpersonal skills to build and maintain strong relationships. • Self-directed and highly organized with the ability to multitask. • Requires excellent judgment, diplomacy, collaboration, partnering, teamwork, and customer service skills. • Ability to maintain confidentiality of all personal/health sensitive information. • Knowledge of and experience within Epic is preferred. • Basic computer proficiency, including Microsoft Suite applications. Benefits • Working at Boston Medical Center is more than a job; it’s a chance to make a difference. • Recognized as a top employer and best place to work. • Strong sense of teamwork and support for staff. Apply tot his job Apply tot his job