POSITION SUMMARY: 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. The Prior Authorization Specialist role belongs to the Revenue Cycle Patient Access team and is responsible for coordinating 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). The role ensures timely access to care while maximizing BMC hospital reimbursement. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations. This position reports to the Patient Access Supervisor and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, Boston Medical Center (BMC) practice staff, case management and Patient Financial Counseling. This is a Remote Position. Position: Prior Authorization Specialist I Department: Insurance Verification Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: RESPONSIBILITIES/DUTIES: - Prioritizes incoming Prior Authorization requests. - Processes incoming requests, including authorizing specified services, as outlined in departmental policies, procedures, and workflow guidelines. - Refers authorization requests that require clinical judgment to Prior Authorization Clinician, Manager, or Medical Director. - Meets or exceeds position metrics and Turn-Around Timeframes while maintaining a full caseload. - 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. - Informs provider of decision per department procedure. - Coordinates resolution of escalated member or provider inquiries as related to Prior Authorization. - Works with members, providers and key departments to promote an understanding of Prior Authorization requirements and processes. - Maintains general understanding of applicable sections of member handbooks, and evidence of coverage. - Monitors accounts routed to registration and prior authorization work queues and clears work queues by obtaining all necessary patient and/or payer-specific financial clearance elements in accordance with established management guidelines. - Maintains knowledge of and complies with insurance companies’ requirements for obtaining prior authorizations/referrals, and completes other activities to facilitate all aspects of financial clearance. - Acts as subject matter experts in navigating both the BMC and payer policies to get the appropriate approvals (authorizations, pre-certs, referrals, for example) for the scheduled care to proceed. The Authorization Specialist is an important part of the larger patient care team and helps clinicians understand what payer requirements are necessary for the widest possible patient access to services. - Uses appropriate strategies to underscore the most efficient process to obtaining insurance verification, authorizations and referrals, including on line databases, electronic correspondence, faxes, and phone calls. - Obtains and clearly documents all referral/prior authorizations for scheduled services prior to admission within the Epic environment. - Works collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients and any other parties to ensure that required managed care referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments/visits prior to scheduled patient visits or retro-actively if not in place at the time of the appointment/visit. Ensure that approval numbers are appropriately linked to the relevant patient appointment/visit. - Collaborates with patients, providers, and departments to obtain all necessary information and payer permissions prior to patients’ scheduled services. - Liaison between physician and payer for peer to peer review when needed - Escalates accounts that have been denied or will not be financially cleared as outlined by department policy - Interview patients, families or referring physicians via telephone in advance of the patient’s appointment/visit whenever possible, to obtain all necessary information, including but not limited to, financial and demographic information required for reimbursement and compliance for services rendered. - Ensure that all updated demographic and insurance information is accurately recorded in the appropriate registration systems for primary, secondary and tertiary insurances. - Review all registration and insurance information in systems and reconcile with information available from insurance carriers. For any insurance updates, utilize any available resources to validate the updated insurance information, insurance plan eligibility, primary care physician, subscriber information, employer information and appointment/visit information. Contact patients as necessary if clarifications or other follow-up is required, and at all times maintain sensitivity and a clear customer friendly approach. - For self-pay patients or patients with unresolved insurance, and for financial counseling, refer patients Patient Financial Counseling. - Maintains confidentiality of patient’s financial and medical records; adheres to the State and Federal laws regulating collection in healthcare; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately. - Participates in educational offerings sponsored by BMC or other development opportunities as assigned/available and complies with all applicable organizational workflows, as well as established policies and procedures. - Demonstrates knowledge & skills necessary to provide level of customer experience as aligned with BMC management expectations. - Demonstrates the ability to recognize situations that require escalation to the Supervisor. - Takes opportunity to know and learn other roles and processes and works together to assist with process improvement initiatives as directed. - Consistently meets productivity and quality expectations to align performance with assigned roles and responsibilities. - Handle ACD telephone calls and emails in a timely fashion, following applicable scripting and customer service standards. Appropriately manage all calls by either working with the customer or referring the call to the appropriate party. - Regularly undergo Quality Audits to achieve the required standard. - Contact the Help Desk in the BMC Information Technology Department to report faulty systems or hardware. Notify area supervisor or manager if problem is not addressed in a timely manner. For other broken or malfunctioning equipment to be serviced, contact the appropriate vendor or department and notify supervisor. - Communicate with all internal and external customers effectively and courteously. - Attend all necessary hospital and department training as required. - Assists in the orientation of new personnel under the direction of a manager or Supervisor. - Perform other related duties as assigned or required. (The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). Must adhere to all of BMC’s RESPECT behavioral standards. JOB REQUIREMENTS EDUCATION: - High school diploma or GED required. - Associate’s Degree or higher preferred. CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED: None. EXPERIENCE: - 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. ​ KNOWLEDGE, SKILLS & ABILITIES (KSAs): - 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 - Effective collaboration skills - Strong oral and written communication skills - 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. - Excellent interpersonal skills to build and maintain strong relationships with managers, colleagues, and third party payers. - 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. - Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. - Knowledge of and experience within Epic is preferred. - Demonstrates technical proficiency within assigned Epic work queues and applicable ancillary systems, including but not limited to: ADT/Prelude/Grand Centrale. - Must be able to maintain strict confidentiality of all personal/health sensitive information. - 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. - Knowledge of medical terminology and/ or coding. Compensation Range: $25.42- $30.97This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, and licensure/certifications directly related to position requirements. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.

Cottingham & Butler is seeking a Knowledge Systems Specialist to build, maintain, and enhance our enterprise knowledge base so staff can easily access accurate, organized information—both directly and through AI‑powered tools. This role owns the structure, governance, and day‑to‑day administration of our SharePoint-based knowledge system and partners with Technology teams to integrate knowledge assets into emerging AI solutions. This is a hands-on role suited for someone who loves organizing information, designing intuitive content structures, and exploring how knowledge and AI intersect. What You’ll Do - Design and maintain the enterprise knowledge base in SharePoint, including taxonomy, metadata, and navigation. - Establish content governance, including naming conventions, version control, and content lifecycle standards. - Partner with subject matter experts to capture, organize, and maintain knowledge assets. - Create documentation standards and templates to support consistent, high‑quality content. - Monitor usage and feedback to improve content quality and findability. - Integrate SharePoint content with internal and external tools (e.g., AWS) for AI-powered retrieval. - Support configuration and optimization of RAG (Retrieval-Augmented Generation) solutions. - Test and validate AI-generated responses for accuracy and alignment with source content. - Stay current on emerging knowledge management and AI technologies. - Provide training, onboarding, and support for content contributors. - Champion knowledge sharing and drive adoption of knowledge management tools. - Create user guides, FAQs, and self‑service resources. Required Qualifications - Bachelor’s degree in Information Science, IT, or related field — or equivalent experience. - 2+ years in knowledge management, content management, or information architecture. - Hands-on experience with SharePoint or similar content management platforms. - Strong understanding of taxonomy, metadata, and content organization. - Excellent written communication and documentation skills. - Ability to work effectively with technical and non‑technical stakeholders. Preferred Qualifications - Experience with AI/ML concepts, especially RAG or knowledge retrieval systems. - Familiarity with AWS (S3, Bedrock) or similar cloud platforms. - Experience creating content governance frameworks. - Background in insurance, financial services, or similar industries. - Familiarity with Microsoft 365 tools beyond SharePoint (Teams, Power Platform). Skills & Competencies Information architecture, technical aptitude, communication and training skills, attention to detail, curiosity about AI, and adaptability in a rapidly evolving environment. About Cottingham & Butler: At Cottingham & Butler, we sell a promise to help our clients through life’s toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals in the industry. We look for people with an insatiable desire to succeed, are committed to growing, and thrive on challenges. Our culture is guided by the theme of “better every day” constantly pushing ourselves to be better than yesterday – that’s who we are and what we believe in. As an organization, we are tremendously optimistic about the future and have incredibly high expectations for our people and our performance. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day. Want to learn more? Follow us on www.CottinghamButler.com | LinkedIn | Facebook

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well. As a Business Analyst – Sales Operations, you will serve as the primary bridge between our B2B, Inside Sales, and IT teams to translate business needs into technical solutions. You will engage in deep-dive discovery to gather granular requirements and author the user stories that drive our Salesforce, Web, AI, and broader technology roadmaps. You own the transition from conceptual sales needs to high-performing technical reality, ensuring every system enhancement is meticulously validated, documented, and launched with the training necessary to drive immediate sales impact. SKILLS Duties and Responsibilities: Sales Process Improvement: - Workflow Optimization: Partner directly with B2B and Inside Sales teams to analyze current workflows, identify friction points, and propose technology-driven improvements. - Discovery: Conduct comprehensive process discovery sessions to translate front-line sales challenges into actionable functional requirements and visual Lucid Chart diagrams. - Strategic Prioritization: Collaborate closely with Sales Leadership to evaluate and prioritize incoming technology requests, ensuring the roadmap aligns with the highest impact business goals. Execution & Lifecycle Management: - Manage the end-to-end delivery of system enhancements, ensuring projects move steadily through the development pipeline. - Story Development: Collaborate with the IT Business Analyst to translate business requirements into refined User Stories and technical specifications in Salesforce and other tools. - Perform rigorous User Acceptance Testing (UAT) to validate that technical builds solve the intended sales problems. - Create and maintain comprehensive documentation on current and future Sales processes. AI Innovation & Emerging Technology - Technology Scouting: Proactively research emerging sales technologies and AI trends to identify new opportunities for automation, lead generation, and workflow efficiency. - AI Product Ownership: Serve as the functional lead for AI sales tools, gathering requirements from the field on how AI can better support prospecting, coaching, and automation. - Prompt & Logic Design: Collaborate with IT and AI developers to write and refine user stories specifically for AI prompt engineering, content governance, and tool integrations. - Content Lifecycle Management: Establish a rigorous cadence for reviewing and updating AI knowledge bases, prompts, and playbooks to ensure all outputs are always up to date with current brand standards and sales. Knowledge, Skills, and Abilities: - Bachelor’s degree is required in business, information systems, or a related field. - 3-5 years of experience in Sales Operations, Business Analysis, or a Systems-focused role. - Proven experience in business analysis or product ownership, specifically within a Salesforce environment. - Expertise in writing high-quality User Stories, managing backlogs, and leading UAT. - Strong ability to "speak both languages” navigating technical conversations with IT and strategic conversations with Sales. - Exceptional organizational skills with a passion for documentation and process mapping. - Experience managing or curating content for AI/Large Language Model tools is a significant plus. Work-at-home requirements - Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. - A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. - Latency (ping) response time lower than 80 ms - Hotspots, satellite and wireless internet service is NOT allowed for this role. - A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you - Competitive pay/salary ranges - Incentive plan - Health/Vision/Dental benefits effective day one - 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution - Robust employee well-being program - Paid Time Off - Personal Community Enrichment Time - Company-provided Basic Life and AD&D - Company-provided Short-Term & Long-Term Disability - Tuition Assistance Program While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer. The hiring range for this position is $70,882 - $89,670 USD. At G.E.H.A, the current maximum salary for this role is $99,918 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization. G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.

About the Opportunity The Bouve ́College of Health Sciences seeks a Grants Administrator or Senior Grants Administrator to join our team in the Bouve ́ College office of Research (BCORe). The title is dependent on qualifications and years of experience. Knowledge and experience of the full life-cycle (pre-award and post-award) of research grants administration is preferred; however, the focus of responsibilities will be on the POST-AWARD administration. The BCORe Team is staffed with six full-time grants administrators which includes the Executive Director of Research Administration and Associate Director of Post Award. Position Summary: The Grants Administrator/Senior Grants Administrator serves as a member of a team of professionals in the Bouve ́College Office of Research (BCORe), primarily responsible for assisting faculty and departmental administrative staff throughout the grants management life-cycle. On the post-award side, this may include: provide timely routine and ad hoc reports to PI's on their grants; manage and monitor grant funding including payroll and non-salary expenditure review; adjust payroll distribution as needed; submit cost transfer requests as needed; monitor grant effort, communicate external regulations to faculty and staff; serve as a primary liaison for BCORe with the central office, Northeastern University Research Enterprise Services (NU-RES); review sponsor financial reports; and oversee project activity through closeout. The Grants Administrator/Senior Grants Administrator may also provide cross functional support to pre-award colleagues in BCORe on a limited basis. This may include: supporting the development and submission of federal, non-federal, state, foundation, corporate, and industry grant proposals. This person may assist with the development of proposal budgets; coordination of sub-contracts on proposals; check for compliance with institutional policies and sponsor requirements; and review grant proposals prior to submission to the central office, Northeastern University Research Enterprise Services (NU-RES). The Grants Administrator/Senior Grants Administrator will also support the research data management functions and research reporting of Bouve ́ as needed. This includes management of transaction logs, running periodic reports of proposal and award activity and trends within College and related Bouve ́ faculty. Responsibilities: - Perform ongoing operational tasks within assigned workstream, which may include: - Post-Award Support: Monitor sponsor award spending for allowability and compliance with federal and sponsor regulations. Managing payroll and sponsored project effort oversight. Develop and monitor budgets and award burn-rate to confirm good financial standing. Assist with the submission of annual progress reports and final reports in collaboration with NU-RES. Proactively follow cleanup and closeout procedures on expired accounts according to institutional policy and good accounting practices. Liaise with NU-RES and complete administrative paperwork as required. - Data Management: Maintain transaction activity logs and awards documents. Run periodic reports of proposal and award activity and trends within College and related to Bouve ́ Faculty. - Occasional Pre-Award Support: Assist principal investigators with proposal and budget preparation, including support with biosketches, other support pages, federal and foundation proposals. Follow compliance regulations established by funding agencies and by the university. Work closely with other BCORe staff, PIs, NU-RES officials and department administrators for proposal submission and award administration. - Work with Principal Investigators, Administration and sponsors to provide excellent customer service and resolve complex issues related to sponsored project. - Develop and manage relationships across key sponsored research stakeholders; communicate with researchers, administrators, and sponsors to facilitate timely proposal submissions. - Ensure provision of customer service assistance to outside agencies in the ongoing administration of grants and contracts. - Keep up-to-date on sponsor requirements, institutional policies, and state and federal regulations, and proactively update team members on applicable changes. Qualifications: - Grants Administrator: Bachelor's degree required and 2 – 5 years of experience - Senior Grants Administrator: Bachelor’s degree required and 4 – 6 years of experience in pre- and/or post-award grant administration, preferably in an academic setting with broad understanding of academic operations and research required. Masters preferred for Senior Grants Administrator level. - 3-5 years of grant accounting support experience is preferred. CRA or CFRA highly desired. - Must be comfortable working independently and as part of a team, and be comfortable meeting deadlines and balancing competing priorities. - Demonstrate technical proficiency required to do the job; possess knowledge in the profession; provide technical expertise to others; have and use cross-functional knowledge to support interdepartmental connections. - Knowledge of and experience in federal regulations including OMB Uniform Guidance, FAR, and other sponsor agency policies and regulations to maintain compliance with terms and conditions of the award. - Knowledge of regulations relating to federal grants and award administration. Direct experience submitting proposals, managing awards, and working with research investigators. - Demonstrate written and verbal communication and interpersonal skills. Strong customer service orientation. Experience in maintaining confidential materials. - Strong organizational skills, attention to detail, and ability to manage deadlines. - Previous use of Workday Finance is strongly preferred. - Proficiency with financial analytical tools, especially Excel (pivot tables, filters, basic formulas) and reporting tools such as Cognos - Familiarity with other research administration systems (e.g., NIH ASSIST, Grants.gov, eRA Commons, Research.gov or similar) would be helpful. Key Responsibilities & Accountabilities - Award Management (75%) Manage portfolio of awards in accordance with sponsor, contract, and University guidelines. Ensure that Bouvé awards are in line with proposal budget. Assist PIs with re-budgeting and carryover request. Work with PIs and NU-RES on just-in-time (JIT) and review notice of award documents for accuracy. Work with PIs on the submission of annual progress reports (eg RPPR), final progress reports, and the proper closeout of awards in alignment with institutional and sponsor guidelines. Work with PI's to monitor spending burn rates on awards, and monitor expenses against the budget. Prepare incremental budgets for new budget periods on awards for PI approval, then work with NU-RES to ensure accurate account setup. Monitor effort for PI's and their staff funded on federal and non-federal awards. Review on an on-going basis the expiring projects to determine whether incremental funding is anticipated or whether a no-cost extension will be required. Reconcile accounts and ensure that accounts in deficit have a corrective plan of action by review with PIs. Work with faculty, the Bouvé College Office of Research, and the NU-RES grant officers on payroll distribution forms, course buyouts, and agreements such as consultant agreements or MOUs. Meet routinely with faculty and review account and project spending as required. - Data Management (10%) Maintain transaction activity logs and awards documents. Run periodic reports of proposal and award activity and trends within the college and related to Bouvé Faculty. - Research Support (10%) Participate in the overall activities of the Bouvé College Office of Research (BCORe) and work with other BCORe staff in all aspects of research support. Participate in NU-RES workshops, brown bag Lunches and trainings. Keep detailed records of submitted proposals, awarded grants, upcoming reporting deadlines, and anticipated funding. Manage electronic records including: correspondence on financial transactions, award notices, and all grant related requests coming from NU-RES, other internal stakeholders, and sponsors. Maintain physical award files to track award notices, increments, and subcontract data. Assist with workshops or trainings offered by BCORe to the Bouvé research community. Assist with the creation of templates for the Bouvé research community. Serve as backup to other BCORe staff, as needed. - Proposal Development & Submission (5%) Assist principal investigators with proposal and budget preparation, including support with biosketches, other support pages, federal and foundation proposals. Follow compliance regulations established by funding agencies and by the university. Work closely with other BCORe staff, PIs, NU-RES officials and department Perform compliance checks for agency proposal requirements, including budget preparation, prior to submitting proposals to NU-RES. Northeastern University will not provide H-1B, TN, O-1, E-3, or any other type of employment visa sponsorship for the successful applicant to this position, now or in the future. Furthermore, the successful applicant must be able to maintain valid work authorization in the United States throughout the entire appointment without Northeastern University’s sponsorship for a visa. Expected Hiring Range Grants Administrator: $53,615 - $75,728 Senior Grants Administrator: $67,855 - $95,845 Position Type Research Additional Information Northeastern University considers factors such as candidate work experience, education and skills when extending an offer. Northeastern has a comprehensive benefits package for benefit eligible employees. This includes medical, vision, dental, paid time off, tuition assistance, wellness & life, retirement- as well as commuting & transportation. Visit https://hr.northeastern.edu/benefits/ for more information. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to race, religion, color, national origin, age, sex, sexual orientation, disability status, or any other characteristic protected by applicable law. Compensation Grade/Pay Type: 107S Expected Hiring Range: $53,615.00 - $75,728.75 With the pay range(s) shown above, the starting salary will depend on several factors, which may include your education, experience, location, knowledge and expertise, and skills as well as a pay comparison to similarly-situated employees already in the role. Salary ranges are reviewed regularly and are subject to change.