Prior Authorization Specialist I – Patient Access Services

Boston Medical Center (BMC)

. Coordinate financial clearance activities, including pre-registration, insurance verification, referrals, authorizations, and precertifications .

Posted 10/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $25 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in financial clearance processes, including insurance verification, prior authorization, and pre-certification, while maintaining compliance with healthcare regulations. Proficient in utilizing Epic and other ancillary systems to manage high-volume requests with accuracy and efficiency.

Highest-signal resume keywords

Financial Clearance ProcessesInsurance VerificationPrior AuthorizationEpic ProficiencyCustomer Service

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance VerificationPrior AuthorizationPre-CertificationFinancial ClearanceICD-9 CodingCPT CodingData EntryMedical TerminologyHigh-Volume Request ProcessingConfidentiality Compliance

Soft Skills

Independent Decision-MakingTime ManagementCommunicationProblem-SolvingCollaboration

Tools & Technologies

EpicCCMSFacetsMicrosoft ExcelMicrosoft WordMicrosoft OutlookZoomADTPreludeGrand Centrale

Industry Keywords

HealthcareInsurance PayerReferral AuthorizationsThird-Party BillingPatient Financial CounselingBMC PoliciesQuality AuditsRegulatory ComplianceHigh-Volume Data EntryCustomer Service Standards

About the role

Key responsibilities & impact

Coordinate financial clearance activities, including pre-registration, insurance verification, referrals, authorizations, and precertifications
Prioritize and process incoming prior authorization requests
Refer requests requiring clinical judgment to the Prior Authorization Clinician, Manager, or Medical Director
Answer ACD calls, verify member eligibility, and enter information into CCMS or Facets
Identify network providers, services, and member benefits
Inform providers of authorization decisions and coordinate escalated inquiries
Monitor registration and prior authorization work queues and obtain required financial clearance elements
Navigate BMC and payer policies to obtain approvals for scheduled care
Obtain and document referrals and prior authorizations in Epic
Collaborate with practices, physicians, insurance carriers, patients, and departments to secure required permissions
Liaise between physicians and payers for peer-to-peer reviews
Escalate denied or uncleared accounts according to policy
Interview patients, families, and referring physicians to collect demographic, financial, and insurance information
Validate and update demographic, insurance, eligibility, subscriber, employer, and appointment information
Refer self-pay or unresolved-insurance patients to Patient Financial Counseling
Maintain confidentiality and comply with healthcare collection laws and regulatory policies
Handle telephone calls and emails according to customer service standards
Participate in training, quality audits, orientation of new personnel, and process improvement initiatives
Report faulty systems or equipment and perform other assigned duties

Requirements

What you’ll need

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, health care office, or hospital administration
Experience using insurance payer websites, such as Blue Cross Blue Shield and Medicare
Experience with insurance verification, prior authorization, pre-certification, and financial clearance processes
Ability to process high-volume requests with a 95% or greater accuracy rate
Ability to prioritize workload within specified turnaround timeframes
Thorough knowledge of the financial clearance process
Familiarity with insurance, referral authorizations, and third-party billing procedures
Knowledge of basic medical terminology and ICD-9/CPT coding helpful
Knowledge of and experience within Epic preferred
Technical proficiency in Epic work queues and ancillary systems, including ADT/Prelude/Grand Centrale
Basic computer proficiency, including Microsoft Excel, Word, Outlook, and Zoom
Ability to maintain strict confidentiality of personal and health-sensitive information
Ability to make independent decisions under pressure and manage complex processes
Bilingual preferred

Benefits

Comp & perks

Medical, dental, vision, and pharmacy benefits
Contract increases
Flexible Spending Accounts
403(b) savings matches
Earned time cash out
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
Educational offerings and development opportunities
Remote work