Prior Authorization Specialist

Summary

Join MedCore Solutions, the healthcare division of Bizforce, as a Prior Authorization Specialist! You will be responsible for obtaining prior authorizations for various medical services and medications. This role requires strong communication and organizational skills, along with experience in medical billing and insurance processes. The position offers a remote work-from-home setup with benefits including leave credits, monetary allowance, annual bonus, weekly paychecks, and fixed weekends off. You'll also receive specialized training programs and a competitive salary. MedCore Solutions values a thriving company culture with complete autonomy.

Requirements

• Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
• Strong understanding of medical billing and insurance processes
• Excellent communication and interpersonal skills
• Detail-oriented with strong organizational skills
• Ability to work independently and meet deadlines
• Comfortable working in a remote, work-from-home setup
• Average English communication skills
• Amenable to work in a graveyard shift
• Own Desktop/Laptop
• Computer Processor: Intel I3/AMD Ryzen 3/MAC Intel I5
• RAM: At least 4GB of RAM (8GB is recommended) with sufficient hard disk space available
• Internet Connectivity: At least 20-25 Mbps and up wired Internet Connection
• Back-up Connections & Power Supply: USB sticks, hotspots, signal-based & wireless connections only for back-up
• Permanent Work From Home

Responsibilities

• Review and process prior authorization requests for medical services, procedures, and medications
• Verify insurance (pharmacy) information and eligibility
• Handle patient inquiries regarding authorizations
• Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy
• Accurately document all patient, pharmacy and insurance carrier interactions in EMR
• Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
• Ensure accurate and timely documentation of authorization requests and approvals
• Collaborate with medical billing team to resolve any issues or denials
• Maintain up-to-date knowledge of insurance guidelines and procedures
• Complete other tasks as assigned by providers through EMR/EHR
• Copy, fax and mail documents and information as requested by insurance carrier
• Schedule follow-up appointments, biologic injections and photodynamic therapy treatments
• Assist pathology department with notifying patients of pathology results via telephone
• Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient’s rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
• Provide safe patient-centered, compassionate, and competent care

Benefits

• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary