Prior Authorization Specialist

At Massachusetts General Hospital, we are dedicated to providing the highest quality of care to our patients. To ensure that our patients receive the necessary medical treatments and services, we are seeking a skilled Prior Authorization Specialist to join our team. As a Prior Authorization Specialist, you will play a crucial role in obtaining insurance approvals for medical procedures and medications. We are looking for a detail-oriented and organized individual with excellent communication skills and a strong understanding of insurance policies and procedures. Join our team and make a difference in the lives of our patients.

1. Obtain Prior Authorizations: The main responsibility of the Prior Authorization Specialist is to obtain insurance approvals for medical procedures and medications. This includes reviewing patient medical records, contacting insurance companies, and providing necessary documentation to obtain authorization.
2. Communicate with Insurance Companies: The Prior Authorization Specialist will be responsible for communicating with insurance companies to verify coverage and obtain necessary authorizations. This may include submitting appeals or providing additional information as needed.
3. Collaborate with Healthcare Team: The Prior Authorization Specialist will work closely with physicians, nurses, and other healthcare team members to ensure that patients receive the necessary medical treatments and services. This may involve communicating updates on authorization status and discussing alternative treatment options.
4. Stay Up-to-Date on Insurance Policies and Procedures: It is essential for the Prior Authorization Specialist to have a strong understanding of insurance policies and procedures. This includes staying informed about any changes or updates that may affect the authorization process.
5. Maintain Records and Documentation: Accurate and detailed record-keeping is crucial in the authorization process. The Prior Authorization Specialist will be responsible for maintaining patient records, insurance documentation, and any other necessary paperwork.
6. Educate Patients and Families: The Prior Authorization Specialist may also be responsible for educating patients and their families on insurance coverage and the authorization process. This may involve providing resources and answering any questions they may have.
7. Ensure Compliance: The Prior Authorization Specialist will be responsible for ensuring compliance with all relevant laws, regulations, and hospital policies related to insurance authorizations.
8. Collaborate with Billing Department: The Prior Authorization Specialist will work closely with the billing department to ensure that all authorizations are obtained in a timely and accurate manner. This may involve coordinating with insurance companies to resolve any issues or discrepancies.
9. Maintain Confidentiality: As a healthcare professional, the Prior Authorization Specialist must maintain patient confidentiality and adhere to all HIPAA regulations in handling sensitive patient information.
10. Continuous Improvement: The Prior Authorization Specialist may be responsible for identifying areas for process improvement

According to JobzMall, the average salary range for a Prior Authorization Specialist in Boston, MA, USA is $49,000 - $68,000 per year. This can vary depending on factors such as experience, education, and specific job responsibilities.

Massachusetts General Hospital (Mass General or MGH) is the original and largest teaching hospital of Harvard Medical School located in the West End neighborhood of Boston, Massachusetts, United States. It is the third-oldest general hospital in the United States and has a capacity of 999 beds. With Brigham and Women's Hospital, it is one of the two founding members of Mass General Brigham (formerly known as Partners HealthCare), the largest healthcare provider in Massachusetts. Massachusetts General Hospital houses the largest hospital-based research program in the world, the Mass General Research Institute currently ranked as the eighth-best hospital in the United States by U.S. News & World Report.