Bilingual Prior Authorization, Insurance Verification Specialist

This is a fully remote position, open to applicants in Colombia, +5 more countries.

📋 Description

• Confirm patient insurance eligibility, active coverage, benefits, effective dates, plan type, network status, copays, deductibles, coinsurance, out-of-pocket details, referral requirements, and authorization criteria.

• Record eligibility and benefit information in EZ Derm or the specified workflow.

• Liaise with insurance companies regarding eligibility, benefits, authorization criteria, and pending requests.

• Log insurance calls, documenting the representative's name, reference number, date and time, phone number, information obtained, and subsequent actions.

• Oversee prior authorizations from submission to final resolution.

• Submit prior authorization requests along with complete supporting documentation.

• Monitor status updates, additional information requests, approvals, denials, authorization numbers, approved codes, units, and date ranges.

• Manage prior authorizations for biologic medications.

• Develop and maintain follow-up tasks for unresolved insurance and authorization matters.

• Track pending items until completion, resolution, or escalation.

• Escalate clinical, financial, missing information, denial, delay, or decision-making issues as necessary.

• Handle insurance-related calls as a primary responsibility.

• Offer overflow patient call support as operational demands permit.

• Prepare a daily End of Day report summarizing completed tasks and outstanding items.

• Uphold patient confidentiality and adhere to HIPAA and practice policies.

• Utilize EZ Derm, 3CX, insurance portals, payer systems, task workflows, phone, email, and internal communication tools.

⛳️ Requirements

• Previous experience in a healthcare or medical practice environment.

• Proficient in both English and Spanish.

• Practical experience in verifying insurance eligibility, benefits, coverage, plan specifics, and authorization requirements.

• Experience in managing prior authorizations from submission to resolution.

• Experience in direct communication with insurance representatives via phone.

• Experience in maintaining detailed records, creating follow-up tasks, tracking pending authorizations, and resolving outstanding items.

• Must communicate and write in English clearly and professionally.

• Relevant work experience is required.

• Must present an NBI Clearance and/or Local Police Clearance prior to onboarding.

• Availability to attend video meetings with the camera on as needed.

• Reliable laptop or desktop computer is essential.

• Stable high-speed internet connection of at least 25 Mbps is required.

• Noise-canceling headset is necessary.

• Functional webcam is required.

• A quiet and professional work environment is mandatory.

• Prior authorization experience with biologic medications is strongly preferred.

• Experience with EZ Derm is preferred but not mandatory.

• Familiarity with 3CX or similar business phone systems is preferred but not essential.

🏝️ Benefits

• Dedicated HR & Contractor Support Team.

• Premium VPN Access (Optional).

• HIPAA & Cybersecurity Training + Certification (Provided).

• Top 1% VA Performance Training.

• Client-Approved U.S. Holidays.

• Client-Approved Paid or Unpaid Time Off.

• Access to Tools & Resources.

• Optional Performance-Based Incentives.