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[Hiring] Prior Authorization Specialist I @BMC Company 100 ID-15942

Role Description

This position can support Boston Medical Center Heath System departments at BMC, Good Samaritan, and St Elizabeth’s Hospitals. This position works out of Epic, Meditech, and various payor portals to verify patient’s insurance and obtain authorizations.

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  • Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program.
  • 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 all pre-registration, obtaining referral authorization, or precertification number(s).
  • Ensures timely access to care while maximizing BMC hospital reimbursement.
  • Reports to the Patient Access Supervisor and requires interaction and collaboration 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/hospital administration required.
  • Meditech experience is strongly preferred.
  • Experience using Insurance payer websites (i.e. Blue Cross Blue Shield, Medicare, etc.) preferred.
  • Experience with insurance verification, prior authorization, pre-certification, and financial clearance process.

Requirements

  • Bilingual preferred.
  • Ability to process high volume of requests with a 95% or greater accuracy rate.
  • Ability to prioritize workload when processing referrals and authorization requests per guidelines and within specified Turn Around Timeframes.
  • 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 with managers, colleagues, and third party payers.
  • Must be self-directed and highly organized with the ability to multitask, manage complex processes, and maintain a fair sense of urgency.
  • Requires ability to make independent decisions under pressure.
  • Requires excellent judgment, diplomacy, collaboration, partnering, teamwork, and customer service skills.
  • Ability to maintain confidentiality of all personal/health sensitive information.
  • Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail.
  • Knowledge of and experience within Epic is preferred.
  • Demonstrates technical proficiency within assigned Epic work queues and applicable ancillary systems.
  • Basic computer proficiency including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook, and Zoom.

Benefits

  • Participates in educational offerings sponsored by BMC or other development opportunities as assigned/available.
  • Maintains confidentiality of patient’s financial and medical records; adheres to State and Federal laws regulating collection in healthcare.
  • Adheres to enterprise and other regulatory confidentiality policies.
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