Preauthorization Specialist at Mass General Brigham in Newton, Massachusetts

Posted in Other 5 days ago.

Job Description:


Job Summary:

the direction of the Financial Coordinator Supervisor, en
sures that all information necessary for proper
financial reimbursement for high dollar patient care is analyzed and submitted
to insurance companies for approval prior to the patient's date of service. Collaborates
with insurance companies and physician offices when necessary to verify
eligibility and authorization requirements to ensure financial reimbursement
for services.

Essential Functions:

  • Perform
    all insurance verification for eligibility, coverage, and authorization
    requirements via Web or phone with third party payers.

  • Ensures
    all possible coverages are created and verified, through electronic or
    manual methods, and all discrepancies are resolved. Validates that
    coverages are assigned to appropriate visit. -Collects and validates
    order-related information including office visit, radiology and surgical
    orders. Follows up with ordering provider to verify CPT codes.

  • Escalates
    challenging accounts to team lead to ensure accounts are approved at prior
    to patient appointment/surgery. Escalates non-certified urgent cases to
    appropriate clinical departments and leadership for approval to proceed or
    communicate rescheduling

  • Contacts providers and
    insurance companies to validate data, collect missing information and resolve
    information discrepancies, -Understands clinical guidelines for payors
    requiring authorization to better build cases for authorization requests and
    provide feedback to clinical departments on required notes.

  • Work
    closely with physician offices obtaining authorization for inpatient and
    outpatient services

collaboratively with Case Management for all patients' financial issues and
updating accounts




  • High
    school graduate or equivalent; some college preferred


  • 1-2 years of insurance, third party payor or secretarial
    experience in a health care setting required

    and Skills

  • Medical
    Terminology required

  • Analytical
    ability to gather and interpret data and communicate desired outcomes orally
    and in writing in a professional manner

  • Strong
    communication and interpersonal skills

  • Ability
    to handle multiple duties

EEO Statement

Hospital will provide equal employment opportunities to all applicants and
employees without regard to race, color, religion, gender age, national origin,
disability, marital status, genetic information, veteran or active military
status, gender identity or expression, or sexual orientation.

Primary Location

:MA-Newton-MGH Newton Wellesley Hospital

Work Locations

:MGH Newton Wellesley Hospital2014 Washington StNewton02462




:Newton-Wellesley Hospital(NWH)


:Full-timeStandard Hours:40


:Day JobPosted Shift Description:1 fte

Employee Status

:RegularRecruiting Department:NWH Patient Access

Job Posting

:Apr 5, 2021