Medical Authorization Specialist – Spine Surgery

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

📋 Description

• Oversee and handle surgery authorizations, with a focus on orthopedic and spine procedures.

• Assess authorization prerequisites and validate insurance details.

• Submit prior authorization requests via insurance portals.

• Monitor authorization requests from submission to determination.

• Ensure all documentation and accompanying information are thorough and precise.

• Follow up on pending authorizations and outstanding documentation requirements.

• Keep records of authorization statuses, reference numbers, correspondence, and next steps.

• Support claims-related tasks and insurance verification processes.

• Analyze denied or rejected authorization requests to determine reasons for denial.

• Prepare and submit insurance appeals.

• Collect clinical documentation, notes, reports, and supporting records for appeal submissions.

• Track appeals and ensure timely follow-up.

• Communicate updates and outstanding requirements to team members.

• Navigate various insurance portals and research specific payer requirements.

• Make outbound calls to insurance companies regarding authorizations, appeals, claims, and documentation.

• Document calls, reference numbers, decisions, and follow-up actions.

• Review procedure and insurance codes.

• Reference clinical notes and reports through EHR/EMR systems.

• Prepare reports, spreadsheets, and documentation related to authorizations.

• Maintain tracking spreadsheets and administrative records.

• Handle information in compliance with HIPAA and confidentiality regulations.

⛳️ Requirements

• Prior hands-on experience with surgery authorizations is mandatory.

• Experience navigating various insurance portals is essential.

• Strong knowledge of the prior authorization and insurance appeals processes is required.

• Proven experience communicating directly with insurance companies is necessary.

• Experience in submitting and tracking authorization requests from initiation to completion is required.

• Familiarity with managing authorization denials and supporting the appeals process is essential.

• Ability to identify required documentation and information for different insurance providers.

• Understanding of insurance and medical procedure codes is necessary.

• Capability to review clinical notes, reports, and supporting medical documentation is required.

• Familiarity with EHR/EMR systems such as Epic, Cerner, Athena, or similar platforms is preferred.

• Excellent attention to detail and accuracy is crucial.

• Ability to organize and track multiple authorization cases simultaneously is necessary.

• Capacity to prioritize tasks based on urgency and authorization timelines is essential.

• Strong documentation and follow-up skills are required.

• Professional communication skills when interacting with insurance representatives are necessary.

• Ability to work independently while consistently following cases through to resolution is required.

• Understanding of HIPAA, confidentiality, and precision in handling medical and insurance information is mandatory.

• Must be able to communicate in English clearly and professionally, both verbally and in writing.

• Relevant work experience is a must.

• An NBI Clearance and/or Local Police Clearance must be provided prior to onboarding.

• Availability for video meetings with camera on as needed is required.

• A reliable laptop or desktop computer is essential.

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

• A noise-canceling headset is necessary.

• A functioning webcam is required.

• A quiet and professional work environment is mandatory.

• Preferred qualifications include experience with orthopedic or spine surgery authorizations, familiarity with spine surgery procedure and insurance codes, knowledge of workers’ compensation, and proficiency in Epic, Cerner, Athena, Google Workspace/Google Sheets, Microsoft Teams, along with prior support of a U.S.-based surgical, orthopedic, spine, or specialty medical practice.

🏝️ 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; paid time off is optional and only if offered by the client.

• Access to Tools & Resources, including templates, workflow guides, productivity tools, and client-specific SOP support.

• Optional performance-based incentives, bonuses, or increased hours based on performance.