Prior Authorization Specialist

Job Summary

To support the referral and authorization process for specialty services, the part-time Per Diem Prior Authorization Specialist will manage referrals and authorizations, collaborate with healthcare providers and insurance companies, and ensure timely access to care while working remotely within Massachusetts and Connecticut.

Key responsibilities

• Process referrals and prior authorizations for specialty services, ensuring accuracy and timely documentation
• Collaborate with clinical teams and insurance companies to gather necessary information for referrals and authorizations
• Monitor denial reports, process appeals for denied claims, and maintain the Electronic Referral Tracking Report

Required qualifications

• 1-3 years of medical insurance knowledge
• GED or HiSET required
• Experience with CIS inbox and EMR preferred
• Proficiency with Microsoft Office, including Word and Excel
• Bilingual in English/Spanish preferred