Prior Authorization Specialist I – Patient Access Services

Boston Medical Center (BMC)

Prior Authorization Specialist responsible for screening pre-authorization requests and financial clearance activities at Boston Medical Center. Ensuring timely access to healthcare services and reimbursement processes.

Posted 7/23/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $25 - $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in prior authorization processes, insurance verification, and financial clearance activities while ensuring compliance with healthcare delivery standards. Proficient in managing high-volume requests with accuracy and efficiency, utilizing strong organizational and customer service skills.

Highest-signal resume keywords

Prior Authorization ExperienceInsurance VerificationFinancial Clearance ProcessCustomer Service SkillsBilingual Communication

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

ICD-9 CodingCPT CodingData EntryReferral AuthorizationPre-CertificationInsurance Payer WebsitesMedical TerminologyHigh Volume Request ProcessingAccuracy Rate of 95%Turn Around Timeframes

Soft Skills

Self-DirectedHighly OrganizedMultitaskingExcellent JudgmentDiplomacy

Tools & Technologies

EpicCCMSFacetsMicrosoft ExcelMicrosoft WordMicrosoft OutlookZoom

Industry Keywords

Healthcare ManagementCost Effective Healthcare DeliveryNetwork ResourcesMember BenefitsThird Party Billing Procedures

About the role

Key responsibilities & impact

Responsible for screening prior-authorization and coordination of specialized services requests in the medical care management program, including a broad range of requests for inpatient, outpatient and ancillary services.
Adheres to policies and procedures in order to comply with performance and compliance standards and to ensure cost effective and appropriate healthcare delivery.
Maintains current knowledge of network resources for referral and linkage to member’s and provider’s needs.
Authorizes certain specified services, under the supervision of the manager, according to departmental guidelines.
Per standard workflows, forwards specified requests to the clinician for review and processing.
Answers ACD line calls from providers and other departments and redirects, as needed.
Coordinates all financial clearance activities by navigating all pre-registration (to include acquiring or validating patient demographic, insurance, and other required elements along with insurance verification activities), obtaining referral authorization, or precertification number(s).
Ensures timely access to care while maximizing BMC hospital reimbursement.
Supports Prior Authorization Clinicians.
Answers ACD line calls, verifies member eligibility and enters into CCMS or Facets the information necessary to complete the caller’s request.
Identifies and informs callers of network providers, services, and available member benefits.

Requirements

What you’ll need

High school diploma or GED required
Associate’s Degree or higher preferred
4-5 years of office experience, specifically in either a high volume data entry office, customer service call center or health care office or hospital administration is required
Experience using Insurance payer websites (i.e Blue Cross Blue Shield, Medicare, etc.)
Customer service experience preferred
Experience with insurance verification, prior authorization, pre-certification and financial clearance process.
Bilingual preferred
Ability to process high volume of requests with a 95% or greater accuracy rate
Ability to prioritize work load when processing referrals and authorization requests per guidelines and within specified Turn Around Timeframes
Thorough knowledge of financial clearance process is a must.
Familiarity with insurances, referral authorizations and third party billing procedures
Knowledge of basic medical terminology and ICD-9/CPT coding is helpful.
Must be self-directed and highly organized with the ability to multitask, manage complex processes, and maintain fair sense of urgency
Requires ability to make independent decisions under pressure.
Requires excellent judgment, diplomacy, collaboration, partnering, teamwork, and customer service skills.
Ability to maintain confidentiality of all personal/health sensitive information.
Knowledge of and experience within Epic is preferred.
Basic computer proficiency inclusive of ability to access, enter and interpret computerized data/information including proficiency in Microsoft Suite applications, specifically Excel, Word, Outlook and Zoom.

Benefits

Comp & perks

medical, dental, vision, pharmacy
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