Prior Authorization Specialist

Beth Israel Lahey Health

. Complete financial clearance activities for services rendered in outpatient departments .

Posted 10/5/2026full-timeBeverly • Massachusetts • United StatesJunior💰 $21 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in financial clearance activities, including verifying patient insurance eligibility and understanding medical necessity and authorization requirements. Proficient in using Microsoft applications and capable of communicating complex information effectively.

Highest-signal resume keywords

Financial Clearance ActivitiesMedical Necessity DeterminationCPT, HCPCS, ICD-9, ICD-10 KnowledgeMicrosoft Applications ProficiencyPayer Policies Understanding

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Financial ClearanceInsurance Eligibility VerificationMedical Necessity ReviewAuthorization Requirements DeterminationCPT CodingHCPCS CodingICD-9 CodingICD-10 CodingData DocumentationOperational Reporting

Soft Skills

Professional Customer ServiceEffective CommunicationProblem SolvingTeam CollaborationStress Management

Tools & Technologies

Craneware SoftwareMicrosoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft AccessWeb-Based Applications

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Payer AuthorizationRevenue Cycle ManagementFederal ComplianceState ComplianceContractual Requirements

About the role

Key responsibilities & impact

Complete financial clearance activities for services rendered in outpatient departments
Monitor outcomes to ensure medical necessity and authorization requirements are met
Provide feedback to departments on medical necessity and authorization processes
Verify patient insurance eligibility using online tools and direct payer contact
Identify payer medical necessity determinations before services are rendered and inform departments of failed instances
Request additional information to rerun medical necessity checks when needed
Determine authorization requirements and obtain payer authorization using payer-specific protocols
Coordinate additional information from departments
Identify and escalate issues for resolution; communicate with revenue cycle peers, leadership, and clinical stakeholders
Document interim and final results in appropriate systems
Complete assigned work queues and daily reports to meet productivity and quality standards
Assist with medical necessity review and authorization for urgent or walk-in visits
Refer patients to financial counselors for complex financial issues or inquiries
Follow BIDMC policies, procedures, and training materials to comply with federal, state, and contractual requirements
Identify trends and provide periodic operational, productivity, and quality reports to departments
Perform other activities as needed to support the department

Requirements

What you’ll need

High School diploma or GED required
1-3 years related work experience required
Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) coding, and International Classification of Diseases (ICD-9, ICD-10)
Advanced skills with Microsoft applications, including Outlook, Word, Excel, PowerPoint or Access, and other web-based applications
Ability to communicate moderately complex information in English in varied written formats
Ability to comprehend and communicate complex verbal information in English
Ability to make decisions guided by precedents, policies, and objectives
Ability to address varied problems requiring analysis or interpretation
Ability to follow precedents and procedures, set priorities, and organize work
Ability to work collaboratively in small teams
Ability to provide professional, service-oriented customer service and remain calm in stressful situations
Associate's degree preferred
3+ years of related experience preferred; two or more years of prior work experience in Financial Clearance activities preferred
Knowledge of payer policies for medical necessity/authorization requirements preferred
Prior experience working with Craneware software preferred
Must comply with Beth Israel Lahey Health's influenza vaccination requirement

Benefits

Comp & perks

Influenza vaccination required as a condition of employment
Potential additional compensation through shift differentials, call pay, premium pay, overtime pay, and other applicable additional pay practices