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Prior Authorization Associate Jobs in Massachusetts

Mass General Brigham

Sr. Practice Assistant

Concord, MA · On-site

$19.37 - $27.71/hr

Obtain prior authorizations for imaging studies when required. * Obtain insurance referrals as ... Associate's degree or higher. * Two to four years of experience in a medical office or ambulatory ...

Southcoast Health

Centralized Scheduler

Fairhaven, MA · On-site +1

$18.88 - $30.44/hr

  • Retirement

Obtains required prior authorization for out of network payers prior to scheduling. Monitor for ... Associates Degree in a related field or equivalent combination of education and experience is ...

Southcoast Health

Centralized Scheduler

Fairhaven, MA

$18.88 - $30.44/hr

  • Retirement

Obtains required prior authorization for out of network payers prior to scheduling. Monitor for ... Associates Degree in a related field or equivalent combination of education and experience is ...

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Prior Authorization Associate information

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

What are the key skills and qualifications needed to thrive as a prior authorization associate?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What is a prior authorization associate?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are some common challenges faced by a prior authorization associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.

What are the most commonly searched types of Prior Authorization jobs in Massachusetts?

The most popular types of Prior Authorization jobs in Massachusetts are:

What are popular job titles related to Prior Authorization Associate jobs in Massachusetts?

For Prior Authorization Associate jobs in Massachusetts, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Associate jobs in Massachusetts look for?

The top searched job categories for Prior Authorization Associate jobs in Massachusetts are:

What cities in Massachusetts are hiring for Prior Authorization Associate jobs?

Cities in Massachusetts with the most Prior Authorization Associate job openings:

Prior Authorization Associate jobs near you

Authorization Spec-Surg-Ancillary

Southcoast Health System, Inc.

Fairhaven, MA

$19.38 - $32.30/hr

Full-time

Retirement

Re-posted 16 days ago

Southcoast Health rating

7.0

Company rating: 7.0 out of 10

Based on 75 frontline employees who took The Breakroom Quiz

415th of 887 rated healthcare providers

Job description

Community Focused. Care Driven. 

Join Southcoast Health, where your future is as promising as the care we provide. Our commitment to each other, our patients, and our community is more than a mission - it’s our way of life, and you’ll be at the heart of it. 

Southcoast Health is a not-for-profit, charitable, health system with multiple hospitals, clinics and facilities throughout Southeastern Massachusetts and Rhode Island.  

Nestled in local communities, Southcoast Health provides inclusive, ethical workplaces where our highly skilled caregivers offer world-class, comprehensive healthcare close to home. 

Find out for yourself why Southcoast Health has been voted ‘Best Place to Work’ for 7 years in a row! 

We are searching for a talented Authorization Spec-Surg-Ancillary

 

Hours: 40hrs  

Shift: Day shift with one minor holiday per year; 8:30am - 5:00pm

Location: Southcoast Business Center – Fairhaven, MA    

 

A career at Southcoast Health offers you: 

  • A culture of well-being that embraces, respects, and celebrates the rich diversity of one another and the communities we serve 
  • Competitive pay and comprehensive benefits package 
  • Generous Earned Time Off Package** 
  • Employee Wellbeing Program 
  • 403B Retirement Plan with company match 
  • Tuition assistance / Federal Loan Forgiveness programs 
  • Professional growth opportunities and customized leadership training 

**Available to regular status employees who are scheduled to work a minimum of 24 hours. 

Southcoast Health is an Equal Opportunity Employer. 


Position reports to the Team Leader or designee. Perform a wide variety of duties to secure optimal revenue for all services performed at Southcoast facilities. Enter orders, schedule/cancel/reschedule appointments, determine patient liability prior to service by creating estimate based on individual payer, notify patients of their potential liability in accordance with Federal & State regulations and collect payment electronically. Initiate contact w/patients, physicians, third party payers to obtain pre-certification and authorization for all inpatient and outpatient services. Liaison between third party payers and providers, coordinate peer to peer discussions to authorize surgical and high dollar services. Use critical thinking skills to ensure CPT codes are documented and authorized for appropriate services. Partner with Care Coordination to determine and authorize appropriate level of care. Navigate multiple payer portals to determine requirements for authorization and submit electronic requests. Work with Pharmacy to determine appropriate infusion medication source and obtain authorization for medication/services. Follow-up with payer denials by researching clinical data to support an appeal. Verify coverage and initiate authorization for new patients to be accepted to SE Rehab Department.
  • Associates Degree in a related field or equivalent combination of education and experience is required; Bachelors Degree preferred.
  • Certificate in Medical Terminology is preferred.
  • Coding experience is preferred.
  • Strong keyboard skills with the ability to type 40 words per minute.
  • Proven exceptional customer service skills.
  • Ability to communicate with physicians, patients and third party payers.
  • Proficient with navigating multiple payer portals and web based tools.
  • Over three years of healthcare experience focusing on revenue cycle activities is preferred.

  • Must be fully vaccinated against seasonal Influenza and the COVID 19 virus or to be exempt from the requirement for medical or personal reasons by signing a statement certifying you are choosing to be exempt from vaccination once hired. 

  • Compensation: Pay rate will be determined based on level of experience. 


USD $19.38 - USD $32.30 /Hr.
MUST WORK ON MINOR HOLIDAY PER YEAR

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