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Prior Authorization Jobs in Boston, MA (NOW HIRING)

Saviance

Prior Authorization Specialist I

Boston, MA · On-site

$19.50 - $26/hr

Job Title Specialized Services Coordinator Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad ...

Axelon

Prior Authorization Clinician

Charlestown, MA · On-site

$50/hr

Prior Authorization Clinician Pay Rate: $50/hr Remote Outpatient Home Care experience directly with patients AND Prior Auth experience on the insurance side; provider side is completely irrelevant.

Axelon

Prior Authorization Clinician

Boston, MA · On-site

$50/hr

Prior Authorization payor-side taking criteria and applying to clinical documentation to make sure the requirements are met in an outpatient environment; the expense can be approved. Seeking ...

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site +1

$22.25 - $29/hr

Pharmacy Prior Authorization Specialist - Onco360 Pharmacy Waltham, MA | Full-Time | Starting at $23.00/hr and up Sign-On Bonus: $5,000 for employees starting before August 31, 2026! Join a mission ...

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site

$22 - $28.50/hr

Pharmacy Prior Authorization Specialist - Onco360 Pharmacy Waltham, MA | Full-Time | Starting at $23.00/hr and up Sign-On Bonus: $5,000 for employees starting before August 31, 2026! Join a mission ...

Onco360

Pharmacy Prior Authorization Specialist

Waltham, MA · On-site

$22 - $28.50/hr

Pharmacy Prior Authorization Specialist - Onco360 Pharmacy Waltham, MA | Full-Time | Starting at $23.00/hr and up Sign-On Bonus: $5,000 for employees starting before August 31, 2026! Join a mission ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Boston, MA

Prior Authorization information

See Boston, MA salary details

$14

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$34

How much do prior authorization jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for prior authorization in Boston, MA is $22.70, according to ZipRecruiter salary data. Most workers in this role earn between $18.80 and $25.05 per hour, depending on experience, location, and employer.

What is prior authorization?

Prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. Before the provider delivers the service, they must receive approval from the insurer. This process helps control costs and ensures that the service or medication is medically necessary. It often involves submitting documentation and waiting for a decision, which can sometimes delay patient care. Patients and providers should check with insurance companies to understand which services require prior authorization.

What are the key skills and qualifications needed to thrive as a prior authorization specialist, and why are they important?

To thrive as a Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and healthcare regulations, typically supported by a high school diploma or associate degree in a healthcare-related field. Familiarity with electronic medical records (EMR) systems, insurance portals, and authorization management software is essential. Attention to detail, effective communication, and problem-solving abilities help you navigate complex cases and collaborate with providers and payers. These skills ensure accurate and timely processing of authorizations, minimizing delays in patient care and reducing administrative errors.

What are some common challenges faced by prior authorization specialists, and how can applicants prepare for them?

Prior Authorization specialists often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To prepare for these challenges, applicants should develop strong organizational skills, attention to detail, and a good understanding of medical terminology and insurance guidelines. Familiarity with electronic health records (EHR) systems and the ability to multitask in a fast-paced environment are also valuable assets in this role.

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

AspectPrior AuthorizationMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, healthcare regulations, and sometimes certifications like NCQA or AHIPRequires knowledge of coding, billing procedures, and often certifications like CPC or CCS
Work EnvironmentHealthcare provider offices, insurance companies, or hospitalsMedical offices, billing companies, or healthcare facilities
Employer & Industry UsageUsed by healthcare providers and insurers to approve treatments or proceduresUsed by healthcare providers and billing companies to process claims and payments

While both roles are essential in healthcare administration, Prior Authorization focuses on obtaining approval for treatments, whereas Medical Billing Specialists handle the financial aspects of claims processing. Understanding their differences helps clarify their distinct responsibilities within the healthcare system.

How do I become a prior authorization specialist?

To become a prior authorization specialist, you typically need a high school diploma or equivalent, along with knowledge of medical billing and coding. Relevant skills include attention to detail, communication, and familiarity with insurance policies and electronic health record systems. Certification in medical billing or coding can enhance job prospects.

What career paths follow prior authorization?

Careers following prior authorization include roles such as medical billers, claims processors, healthcare administrators, and utilization review specialists. These positions often require knowledge of insurance policies, medical coding, and healthcare regulations, and may involve certifications like CPC or CCS. Advancement can lead to supervisory or managerial roles within healthcare administration or insurance companies.

What is a prior authorization job?

A prior authorization job involves reviewing and processing requests from healthcare providers to approve specific medical treatments, medications, or procedures before they are administered. The role requires knowledge of insurance policies, medical terminology, and attention to detail, often utilizing electronic health record systems. It is essential for ensuring that treatments meet insurance criteria and are covered under the patient's plan.
More about Prior Authorization jobs

What are the most commonly searched types of Prior Authorization jobs in Boston, MA?

The most popular types of Prior Authorization jobs in Boston, MA are:

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For Prior Authorization jobs in Boston, MA, the most frequently searched job titles are:

What job categories do people searching Prior Authorization jobs in Boston, MA look for?

The top searched job categories for Prior Authorization jobs in Boston, MA are:

What cities near Boston, MA are hiring for Prior Authorization jobs?

Cities near Boston, MA with the most Prior Authorization job openings:

Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Boston, MA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, 1% Temporary, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $47,212 per year, or $22.7 per hour.

Prior Authorization Specialist

Massgeneralbrigham

Somerville, MA • Remote

$28.30/hr

Full-time

Medical

Posted 4 days ago

Job description

Site: Mass General Brigham Incorporated


Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.


Job Summary

Summary
Reviews and processes prior authorization and referral requests for medical services in accordance with organizational policies and payer requirements. Ensures insurance eligibility, coordination of benefits, siteofcare compliance, and medical necessity by gathering and submitting complete medical documentation in alignment with HIPAA standards. Accurately documents authorization outcomes and all payer communications in the electronic health record.
Essential Functions
-Work as part of a group to secure insurance authorizations in an appropriate timeframe. Collects and accurately enters information required by third parties for precertification for procedures, tests and imaging.
-When unclear, collaborates with ordering clinicians to ensure the proper CPT codes are submitted for prior authorization or referrals.
-Refer patients to financial counseling, as appropriate.
-Inform patient of authorization concerns prior to admission/procedure, coordinating with appropriate parties to facilitate authorization as appropriate, collaborating with other departments/offices to resolve complex authorization issues.
-Update authorization status in system and complete workflow.
-Respond to internal and external inquiries regarding authorization decisions and provide explanations as needed.


Qualifications

Education

  • High School Diploma or Equivalent required


Experience

  • Medical authorization or related field experience 1-2 years preferred
  • Epic experience 0-1 year preferred


Knowledge, Skills and Abilities

  • - Excellent attention to detail and organizational skills.
  • - Strong communication and interpersonal skills.
  • - Knowledge of medical terminology and medical insurance benefits, including a complete understanding of the coordination of benefits.
  • - Familiarity with computer systems and databases.
  • - Ability to work independently and as part of a team.
  • - Ability to work in a fast-paced environment.

Additional Job Details (if applicable)

Remote Model Requirements

  • Remote
  • M-F Eastern business hours required
  • Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.


Remote Type

Remote


Work Location

399 Revolution Drive


Scheduled Weekly Hours

40


Employee Type

Regular


Work Shift

Day (United States of America)


Pay Range

$ - $28.30/Hourly

Grade

3


At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.


EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.


Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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