Prior Authorization Specialist

Baystate Health

. Process referrals and prior authorizations for specialty services and testing .

Posted 10/15/2026part-timeRemote • United StatesJunior💰 $23 - $32 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing referrals and prior authorizations, managing electronic tracking systems, and maintaining accurate medical documentation. Proficient in collaborating with clinical teams and insurance companies to ensure compliance with authorization requirements.

Highest-signal resume keywords

Medical Insurance KnowledgeReferral ProcessingPrior Authorization ManagementBilingual in English/SpanishProficiency with Microsoft Office

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Referral ProcessingPrior Authorization ManagementMedical Insurance KnowledgeMedical TerminologyDocumentation Management

Soft Skills

CollaborationCommunicationGuidance and Support

Tools & Technologies

Microsoft OfficeWordExcelCIS InboxEMR

Certifications & Qualifications

GEDHiSET

Industry Keywords

Electronic Referral TrackingDenial ManagementAuthorization RequirementsInsurance CompaniesClinical Team Collaboration

About the role

Key responsibilities & impact

Process referrals and prior authorizations for specialty services and testing
Collaborate with clinical team members, physician offices, agencies, and insurance companies to obtain required information
Monitor denial and no-referral reports
Obtain required authorizations and referrals
Process appeals for denied claims
Manage and maintain the Electronic Referral Tracking Report
Prioritize requests based on urgency and designated criteria
Provide guidance and support on referral and authorization questions and processing issues
Communicate authorization decisions and timely updates to providers, staff, patients, and families
Maintain accurate documentation in patients' medical records
Update referral and authorization statuses
Stay current with insurance authorization requirements and communicate changes, trends, and process updates

Requirements

What you’ll need

1-3 years of medical insurance knowledge
Proficiency with Microsoft Office, Word, and Excel
Experience with CIS inbox and EMR
GED or HiSET (Required)
Bilingual in English/Spanish preferred
Knowledge of medical terminology preferred

Benefits

Comp & perks

Medical, dental, and vision coverage, including local Health New England plans (depending on eligibility)
Tuition assistance
CEUs
Professional development opportunities
Clinical advancement opportunities
Leadership development
Internal career opportunities
Career options across Baystate Health hospitals, practices, and services throughout western Massachusetts
Retirement savings and employer match (depending on eligibility)