Prior Authorization Specialist I - Patient Access Services 830A-5P

### **Prior Authorization Specialist I \- Patient Access Services 830A\-5P** * 50831 * Remote, United States * Full Time **POSITION SUMMARY****:** The Prior Authorization Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating all financial clearance activities by navigating all pre\-registration (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s). The role ensures timely access to care while maximizing BMC hospital reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations. This position reports to the Patient Access Supervisor and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, Boston Medical Center (BMC) practice staff, case management and Patient Financial Counseling. This is a Remote Position. **Position: Prior Authorization Specialist I \- Patient Access Services 830A\-5P** **Department: Insurance Verification** **Schedule:Full Time** **ESSENTIAL RESPONSIBILITIES / DUTIES:** * Prioritizes incoming Prior Authorization requests. * Processes incoming requests, including authorizing specified services, as outlined in departmental policies, procedures, and workflow guidelines. * Refers authorization requests that require clinical judgment to Prior Authorization Clinician, Manager, or Medical Director. * Meets or exceeds position metrics and Turn\-Around Timeframes while maintaining a full caseload. * Supports Prior Authorization Clinicians. * Answers ACD line calls, verifies member eligibility and enters into CCMS or Facets the information necessary to complete the caller’s request. * Identifies and informs callers of network providers, services, and available member benefits. * Informs provider of decision per department procedure. * Coordinates resolution of escalated member or provider inquiries as related to Prior Authorization. * Works with members, providers and key departments to promote an understanding of Prior Authorization requirements and processes. * Maintains general understanding of applicable sections of member handbooks, and evidence of coverage. * Monitors accounts routed to registration and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer\-specific financial clearance elements in accordance with established management guidelines. * Maintains knowledge of and complies with insurance companies’ requirements for obtaining prior authorizations/referrals, and completes other activities to facilitate all aspects of financial clearance. * Acts as subject matter experts in navigating both the BMC and payer policies to