Medical VA – Prior Authorization Specialist

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

📋 Description

• Oversee the complete prior authorization process for healthcare providers.

• Initiate, monitor, and follow up on prior authorization submissions.

• Handle both incoming and outgoing communications with healthcare insurance firms to confirm authorization requirements, obtain status updates, and address unresolved or denied requests.

• Confirm patients' healthcare insurance coverage, benefits, and plan prerequisites prior to scheduling procedures or submitting authorizations.

• Gather pertinent medical histories, clinical notes, and diagnostic reports.

• Serve as the main liaison among medical providers, patients, and payors.

• Determine the causes of authorization denials, collect any missing clinical documentation, and prepare basic appeal packages as guided by healthcare providers.

• Provide administrative support, including data entry, email management, maintenance of authorization tracking logs, and record management.

• Ensure prompt approvals for procedures, medications, diagnostic tests, and specialist referrals.

• Facilitate patient care access, enhance practice workflows, and improve revenue cycle efficiency.

⛳️ Requirements

• A minimum of 6 months to 1 year of experience in prior authorization or healthcare BPO dealing with US healthcare accounts.

• Strong knowledge of insurance portals, EMR/EHR systems, and medical terminology.

• HIPAA Certification is advantageous.

• Excellent time management skills.

• High attention to detail.

• Proficient with computer technology.

• Positive work attitude and a willingness to exceed expectations.

• Availability to work night shifts.

• Primary computer requirements: Intel Core i5-6000 (6th Gen or higher) or AMD Ryzen 5 or better.

• Minimum RAM of 8.00 GB for the primary computer.

• Operating system must be at least Windows 11 64-bit or macOS Ventura.

• USB headset with noise-cancelling capabilities.

• Webcam that provides clear and crisp video output.

• Required backup system or UPS that can support the workstation for at least 3 hours, typically 240Wh or higher.

• UPS must accommodate all necessary plugs for the primary device and work environment.

• Primary internet connection must be DSL/fiber with a minimum speed of 100mb/s contracted.

• Backup internet connection with at least 20mb/s (cellular).

• Must comply with HIPAA regulations and ensure the confidentiality of patient data, insurance information, and communications.

🏝️ Benefits

• Starting salary of $800 (USD) per month.

• Complimentary training provided.

• Paid time off available.

• HMO coverage included.

• Optical rewards offered.

• Opportunities for performance-based increases.

• Permanent work-from-home arrangement.