Prior Authorization Specialist, Neurology

## Prior Authorization Specialist, Neurology Apply:
Hybrid:
Boston-MA:
Full time:
Posted Today:
RQ4080510

Site:
The Brigham and Women's Hospital, Inc.

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
** The Prior Authorization Specialist II supports the Department of Neurology's revenue cycle operations, with a primary focus on prior authorizations, referrals, insurance eligibility verification, and resolution of authorization-related denials. Working closely with providers, clinical teams, and revenue cycle staff, this role ensures timely and accurate processing of payer requirements to support patient care and reimbursement. The position is responsible for obtaining and managing authorizations, working payer denials and appeals related to authorization requirements, and helping remove barriers to care and reimbursement.

The role requires strong attention to detail, effective communication skills, and the ability to navigate complex insurance and authorization processes while maintaining accurate documentation and a high level of customer service.
** Qualifications
* * Education High School Diploma or Equivalent required  Can this role accept experience in lieu of a degree? No  Experience Experience in medical authorization or a related field 2-3 years required and 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.  ## Authorization, Referral, and Eligibility Management
* Obtain insurance authorizations prior to initiation of patient services.
* Ensure all required insurance referrals are received, complete, and accurately documented.
* Perform demographic and insurance eligibility checks in Epic, NEHEN, and other payer systems; update or escalate discrepancies.
* Facilitate referral and prior authorization requests with payers and specialty pharmacies via phone, fax, and payer portals.
* Collect, review, and submit clinical documentation required to support medical necessity and payer authorization requirements.
* Collaborate with providers and clinical staff to obtain information necessary to support authorization requests, reconsiderations, and appeals.
* Independently manage complex, high-cost, high-risk, or time-sensitive authorization requests and escalate issues as appropriate.
* Maintain accurate and timely documentation of all authorization and referral activity in Epic.## ## Authorization Denial & Reimbursement Support
* Maintain working knowledge of payer requirements, coverage guidelines, and eligibility rules across managed care organizations.
* Monitor and take action on work queues related to authorizations, referrals, denials, and appeals, ensuring timely follow-up and resolution.
* Partner with the Lead Managed Care Coordinator, revenue cycle, and billing teams to resolve authorization- and referral-related denials and support reconsiderations, reprocessing, and appeals.
* Assist in identifying and escalating payer or patient-related issues that may impact reimbursement.
* Identify trends in authorization denials or delays and communicate opportunities for improvement to leadership.  ## Operational Workflow Support
* Follow established department workflows and managed care processes.
* Scan provider schedules for non-contracted plans and escalate issues to Practice Administrators or the Lead Managed Care Coordinator.
* Maintain up-to-date tracking mechanisms and records of authorization, referral, denial, and appeal activities.
* Participate in Department Appointment Review (DAR) follow-up activities where applicable.
* Review payer-specific requirements, site-of-care guidelines, and coverage limitations and escalate concerns as appropriate.
* Collaborate with team members to review,…