Insurance Specialist – Prior Authorization

This is a fully remote position, open to applicants in United States.

📋 Description

• Confirm patient insurance eligibility, benefits, and coverage requirements.

• Acquire prior authorizations and referrals from insurance providers as per payer guidelines.

• Interact with insurance companies, provider offices, and patients to gather information essential for authorization approval.

• Investigate and resolve authorization-related issues that may affect patient access to services.

• Assess accounts for medical necessity, payer stipulations, and benefit limitations.

• Record authorization activities and keep precise account documentation.

• Update patient demographic, insurance, and payer details as necessary.

• Track authorization status and ensure prompt follow-up on outstanding requests.

• Utilize payer portals, eligibility tools, and healthcare software systems to facilitate authorization tasks.

• Adhere to established productivity, quality, and accuracy benchmarks.

• Work collaboratively with operational, billing, and clinical teams to promote reimbursement and patient access objectives.

⛳️ Requirements

• High School Diploma or GED.

• Over 2 years of experience in prior authorization, insurance verification, medical billing, patient access, or healthcare revenue cycle.

• Familiarity with Medicare, Medicaid, and commercial payers.

• Knowledge of Workers' Compensation pre-access or authorization procedures.

• Understanding of insurance eligibility, authorization, and benefits verification processes.

• Proficient in Microsoft Office (Outlook, Word, and Excel).

• Prior experience in a hospital, physician practice, or healthcare revenue cycle setting is preferred.

• Experience with Epic, Cerner, Meditech, or other healthcare information systems is preferred.

• Familiarity with payer portals and authorization systems is preferred.

• Knowledge of medical terminology and coding is preferred.

• Previous remote healthcare experience is preferred.

• Must have a secure and private workspace at home.

• Reliable wired high-speed internet connection is required.

• Minimum internet speeds of 30 Mbps download and 10 Mbps upload are needed.

• Ability to maintain a professional and distraction-free work environment during scheduled hours.

• Legally authorized to work in the United States at the time of hire.

• Must successfully pass a pre-employment background check.

• Satisfactory references and any required documentation are necessary.

• Candidates residing in New York state cannot be considered.

• Employment visa sponsorship is not available.

🏝️ Benefits

• Comprehensive Paid Training.

• Medical, Dental & Vision Insurance.

• HSA & FSA Available.

• 401(k) with Company Match.

• Paid Wellness Time & Holidays.

• Employer-Paid Life Insurance & Long-Term Disability.

• Internal Growth Opportunities.

• Work-from-home arrangement.

• Secure and private home workspace.

• Video interviews may be recorded and transcribed to support candidate evaluation, interviewer collaboration, and hiring decisions.