Prior Authorization Representative

Published May 29th, 2024

Hours: Part Time – 24 HPW

  • Flexible schedule – 3, 8 hour days (Office is open 8-5)

Pay: $22 – $25/hr 

Job Description:

  • Looking for someone to train/help and eventually take over ownership of the role handing prior authorizations for medications
  • MA by trade is a preferred but not required
  • Request, track, and obtain prior auths from insurance carriers/third party auth companies within a reasonable timeframe
  • Contact insurance carriers to verify patient’s insurance benefits and requirements specific to the requested procedures
  • Follow up with insurance carriers/third party auth companies prior to  servies being performed to secure authorization
  • Work closely with referring physicians to obtain necessary data needed to submit for prior auth
  • Daily completion of Mass Health insurance checks and verification of eligibility with insurance department for any commercial insurance coverage changes.
  • Answers the phone, provides information and directs calls to the appropriate areas.
  • Assists in department-wide initiatives for improved medication prescribing, such as preferred medications, medication recalls or alerts, medication formulation changes.
  • Performs all job functions in compliance with applicable federal, state, hospital policies and procedures.
  • Handles confidential information in compliance with HIPAA guidelines.


  • High school diploma or equivalent required. College preferred.
  • Proficient in Office 365 and Medical EMR programs; LYTEC a plus
  • Previous Medical Receptionist experience including Mass Health Insurance verification.
  • Successful completion of a Medical Assistant training program preferred
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