Prior Authorization Specialist

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

📋 Description

• Process and submit requests for prior authorization to insurance companies.

• Verify the eligibility, benefits, and coverage of patient insurance.

• Follow up with insurance providers regarding the status of authorizations.

• Communicate in a professional manner with providers, clinic personnel, patients, and insurance representatives through phone and email.

• Maintain precise documentation of authorization requests, approvals, denials, and outcomes.

• Update patient records and EMR/EHR systems with relevant authorization information.

• Investigate and resolve issues related to authorizations, including denials or delays.

• Monitor expiration dates of authorizations and submit renewal requests as necessary.

• Prioritize and manage multiple authorization cases while adhering to deadlines.

• Ensure compliance with HIPAA regulations and uphold patient confidentiality.

⛳️ Requirements

• A minimum of 1 year of experience in medical prior authorizations, medical billing, insurance verification, or a similar healthcare administrative role.

• Experience with EMR/EHR systems.

• Practical experience using insurance portals like TRICARE, UnitedHealthcare (UHC), Availity, and other similar platforms for eligibility verification, authorization requests, and claim status inquiries.

• Exceptional verbal and written communication skills in English.

• Strong organizational abilities with a keen attention to detail.

• Proficient in data entry and familiar with Microsoft Office/Google Workspace.

• Capability to work independently in a dynamic remote environment.

• Knowledge of HIPAA regulations and requirements related to patient confidentiality.

🏝️ Benefits

• Dedicated HR & Contractor Support Team: Receive world-class support for inquiries, guidance, contract matters, and client communication.

• Premium VPN Access (Optional): A secure VPN license is available upon request to enhance privacy and security for client-related tasks.

• HIPAA & Cybersecurity Training + Certification (Provided): Gain access to our internal HIPAA compliance training, cybersecurity modules, and certification to ensure you manage PHI confidently for U.S. healthcare clients.

• Top 1% VA Performance Training: Benefit from our proprietary training on communication, client management, productivity systems, and best practices to excel as a top-performing VA and enhance long-term client retention.

• Client-Approved U.S. Holidays: Contractors are permitted to take U.S. holidays off in accordance with client needs and schedules.

• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client, with paid time off being optional and contingent upon client offerings.

• Access to Tools & Resources: Utilize templates, workflow guides, productivity tools, and client-specific SOP support to optimize your performance.

• Optional Performance-Based Incentives: Certain clients may provide bonuses, incentives, or additional hours based on your performance.