Prior Authorization Specialist I in Boston, Massachusetts - #72551 | VanderHouwen

Description

Job Id: 72551

Prior Authorization Specialist I
Our client is seeking a detail-oriented Prior Authorization Specialist I to support healthcare authorization operations in a fast-paced, fully remote environment. This individual will play a critical role in reviewing authorization requests, coordinating with providers and internal clinical teams, and ensuring timely, accurate processing of healthcare services. The ideal candidate is highly organized, customer-focused, and able to manage competing priorities while maintaining quality and compliance standards.

This role is fully remote.

Prior Authorization Specialist I Responsibilities

• Review, prioritize, and process incoming prior authorization requests for a variety of healthcare services while ensuring compliance with established guidelines and turnaround requirements.
• Gather and verify required clinical and administrative information, following up with providers and other stakeholders to obtain missing documentation when necessary.
• Escalate requests requiring clinical review or medical judgment to appropriate clinical staff, supervisors, or medical leadership.
• Respond to provider and member inquiries, verify eligibility and benefits information, document interactions, and route requests to the appropriate departments.
• Communicate authorization decisions and support the resolution of escalated authorization-related issues in a professional and timely manner.
• Maintain accurate records within healthcare management systems and ensure all communications and documentation meet organizational quality standards.
• Collaborate with internal teams and external providers to promote understanding of authorization requirements, processes, and available healthcare services.
• Participate in departmental operations, including call queue support, voicemail coverage, and other team-based administrative activities.

Prior Authorization Specialist I Qualifications

• Associate degree in Healthcare Administration, Social Work, a related field, or an equivalent combination of education and relevant experience.
• Three or more years of experience in a healthcare administrative, medical office, utilization management, or health plan support role.
• Experience working with healthcare systems, authorization platforms, or claims/utilization management databases; experience with Jiva, FACETS, or similar systems is preferred.
• Strong understanding of health plan operations, member benefits, provider relations, and authorization processes.
• Demonstrated ability to manage a high-volume workload while meeting productivity, quality, and accuracy expectations.
• Excellent customer service, communication, and problem-solving skills.
• Proficiency with Microsoft Office applications and electronic healthcare systems.
• Ability to work independently in a remote environment while collaborating effectively with cross-functional teams.
• Successful completion of a pre-employment background check.

Compensation: (DOE)

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As an eligible contract employee with VanderHouwen, you’ll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.

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