Prior Authorization Specialist

Summary

Join MedCore Solutions as a Prior Authorization Specialist and contribute to our growing healthcare team. You will be primarily responsible for obtaining prior authorizations for various medical services. This role demands strong communication and organizational skills, as you will interact with patients, providers, and insurance carriers. The position offers a permanent work-from-home setup with weekends off and a supportive company culture. Proven experience as a Prior Authorization Specialist in the US healthcare system is required, along with a strong understanding of insurance verification processes. The ideal candidate will be detail-oriented, able to work independently, and comfortable with a graveyard shift.

Requirements

• Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
• Strong knowledge of insurance verification processes and payer/billing guidelines
• Excellent communication and interpersonal skills to work effectively with patients, providers, and insurers
• Detail-oriented with strong organizational skills
• Ability to work independently and meet deadlines
• Comfortable working in a remote, work-from-home setup
• Amenable to work in a graveyard shift
• Device (Desktop or Laptop)
• Windows Devices : Intel Core i5 (or higher) or AMD Ryzen 5 (or higher)
• Mac Devices : Apple M1 chip or newer
• RAM : Minimum of 8GB or higher for optimal performance
• Windows : Windows 11 Pro (Windows 10 Pro is acceptable but not preferred). The operating system must have a legitimate license
• Mac : macOS compatible with M1 or newer chips
• Hard Disk : At least an SSD for faster processing and performance
• Internet Connectivity : Minimum speed of 50 Mbps via a wired connection for stability and reliability

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 patient care

Preferred Qualifications

• A backup internet connection is highly recommended
• A backup power supply (e.g., UPS or generator) to prevent disruptions during power outages (optional but encouraged)

Benefits

• Permanent Work From home
• Permanent Weekends Off
• Great Company Culture and No Micromanagement