Outwork Staffing is hiring a
Pre-Authorization Specialist

Summary

A remote Pre-Authorization Specialist role is available for candidates from Latin America to support an Interventional Pain Management group practice. The specialist will provide administrative support, verify medical insurance coverage, apply ICD-10 and CPT codes, process prior authorization requests, and communicate with patients, insurers, and healthcare providers.

Requirements

• Bachelor's degree in healthcare administration, business administration, or related field preferred
• Strong communication skills
• Experience in verifying medical insurance coverage
• Ability to review and interpret medical documents
• Experience evaluating patient requests for coverage authorizations
• Strong understanding of ICD-10 and CPT coding systems for accurate medical billing and insurance claims
• Ability to efficiently use various insurance provider portals for submitting claims, reviewing coverage, and obtaining authorizations
• Excellent organizational skills, attention to detail, and ability to prioritize tasks effectively

Responsibilities

• Verify medical insurance coverage
• Navigate and manage tasks through insurance portals
• Apply knowledge of ICD-10 and CPT codes for accurate medical billing and documentation
• Understand and determine the rules of medical necessity
• Process prior authorization requests
• Ensure accurate data entry
• Evaluate individual requests for coverage authorizations
• Understand criteria prior to submitting
• Obtain pre-approval from insurance companies for patient medications and treatments
• Communicate with patients, insurers, and other appropriate parties
• Review and interpret medical documents