Authorizations Specialist, US Healthcare

This is a fully remote position, open to applicants in South Africa.

📋 Description

• Oversee the submission and management of insurance authorization requests, ensuring they progress through approval, denial, or reauthorization stages.

• Assess patient information and clinical documentation to confirm compliance with payer and authorization criteria.

• Track authorization statuses, expiration dates, and forthcoming appointments to identify any gaps or delays.

• Facilitate Single Case Agreements (SCAs) and deliver status updates to pertinent teams.

• Complete online enrollments related to compliance programs, patient benefits, and payer or treatment prerequisites.

• Handle payer-specific requirements, including TRICARE referrals and authorizations.

• Process and oversee pharmacy prior authorizations and medication-related approvals.

• Ensure accurate documentation of authorization, payer, enrollment, and patient information in Salesforce and other relevant systems.

• Prepare and manage documentation related to evaluation and billing.

• Engage in communication with insurance carriers, billing partners, healthcare providers, pharmacy partners, and internal teams.

• Follow up on outstanding requests, missing documentation, denials, enrollments, and other barriers to treatment.

• Generate required reports and assist in tracking authorization and patient scheduling activities.

• Aid in developing and documenting workflows specific to authorization, enrollment, and payer requirements.

• Contribute to system and workflow enhancement initiatives aimed at boosting efficiency and minimizing delays in patient care.

⛳️ Requirements

• Prior experience in healthcare insurance authorizations, medical aid authorizations, benefits verification, medical billing, claims, utilization management, or similar healthcare administration is preferred.

• Familiarity with medical aids, insurance providers, payer portals, or online healthcare enrollment systems is beneficial.

• A solid understanding of insurance benefits, prior authorizations, referrals, claims, and payer requirements is preferred.

• Exceptional organizational and time-management abilities, with a keen attention to detail and accuracy.

• Strong written and verbal communication skills.

• Capability to handle multiple cases, priorities, deadlines, and follow-ups concurrently.

• Excellent problem-solving and critical-thinking capabilities.

• Proactive and self-motivated, able to independently pursue outstanding tasks and see them through to completion.

• Comfortable with technology and quick to learn new systems; experience with Salesforce is advantageous.

• Ability to collaborate effectively with clinical, administrative, billing, pharmacy, and other internal teams.

• Capacity to maintain confidentiality and manage sensitive patient information appropriately.

• Flexible and at ease in an environment where processes and workflows may evolve and improve.

• Previous experience supporting a U.S. healthcare client or familiarity with U.S. insurance/payer requirements is beneficial.

• Availability Monday–Friday from 09:00–18:00 EST / 15:00–00:00 South African time, subject to daylight savings.

• Willingness to work on South African and U.S. public holidays.

• A fixed fibre line with a minimum of 25 Mbps upload and download speeds and wired Ethernet capability.

• Reliable power backup for load shedding or outages.

🏝️ Benefits

• Compensation for South African public holidays in accordance with the BCEA.

• Fully remote work arrangement.