Prior Authorization Specialist at Holyoke Medical Center – Springfield, Massachusetts

Note: The compensation range noted above represents the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range.

Valley Health Systems, Inc., the parent company of Holyoke Medical Center, provides a broad range of physician services in offices conveniently located throughout Western Massachusetts.

Holyoke Medical Center is an independent community hospital that has served the healthcare needs of the Pioneer Valley for over 125 years. We continue to grow and address the needs of our community through quality and patient-centered care.

We are seeking an experienced Prior Authorization Specialist to join our Neurology & Sleep Center Office to be responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, coordinating patient appointments and orders.

Overview of Responsibilities include but are not limited to:

• Verify patient insurance eligibility, benefits, and requirements with carriers
• Maintain strong knowledge of various insurance plans (HMO, PPO, Medicare, Medicaid, etc.)
• Request, track, and obtain pre-authorizations within required timeframes
• Secure prior authorizations before services are performed
• Apply medical terminology knowledge and follow office procedures, including HIPAA compliance
• Assist with medical necessity documentation to support timely approvals
• Ensure accuracy and completeness of authorization requests and supporting documents
• Review denials and coordinate with providers to gather information for appeals.
• Prioritize authorization requests based on patient urgency
• Document all communications clearly and maintain productivity while sharing insurance updates with the team.

Qualifications:

Education: High School Diploma or equivalent

Experience: Two years of experience in a physician's office obtaining prior authorizations for medications; knowledge of insurance process and medical terminology preferred.

Special Aptitudes & Activities: Excellent communication and interpersonal skills, along with strong typing, transcription, filing, and computer proficiency. Ability to accurately follow verbal and written instructions while maintaining high organization, attention to detail, and effective multitasking. Capable of managing multiple responsibilities efficiently in a fast-paced environment.

Our competitive salary package is adjusted to align with a candidate's relevant experience and skills. We also offer:

• Low cost health insurance with no deductibles when using HMC services

• Dental and vision insurance

• Free disability and life insurance

• 403(b) plan

• Up to $8000 in degree/tuition reimbursement

• In-House Pharmacy

• Relaxation Room and Fitness Center

• Other voluntary benefits, such as LegalShield, Pet Insurance

• Free onsite parking