Prior Authorization Specialist

Job Title: Prior Authorization Specialist

Job Code: [JW-BOD]

Position Type: Full-time

Work Hours: 8:00 AM - 5:00 PM Eastern Daylight Time, Monday - Friday

Salary rate: $5 - $6 per hour

Job Responsibilities:

• Process and submit prior authorization requests to insurance companies.
• Verify patient insurance eligibility, benefits, and coverage.
• Follow up with insurance carriers regarding authorization status.
• Communicate professionally with providers, clinic staff, patients, and insurance representatives via phone and email.
• Maintain accurate documentation of authorization requests, approvals, denials, and outcomes.
• Update patient records and EMR/EHR systems with authorization information.
• Investigate and resolve authorization issues, denials, or delays.
• Monitor authorization expiration dates and submit renewal requests as needed.
• Prioritize and manage multiple authorization cases while meeting deadlines.
• Ensure compliance with HIPAA regulations and maintain patient confidentiality

Requirements

• At least 1 year of experience in medical prior authorizations, medical billing, insurance verification, or a related healthcare administrative role.
• Experience working with EMR/EHR systems.
• Hands-on experience using insurance portals such as TRICARE, UnitedHealthcare (UHC), Availity, and similar payer portals for eligibility verification, authorization requests, and claim status inquiries.
• Excellent verbal and written English communication skills.
• Strong organizational skills with exceptional attention to detail.
• Proficient in data entry and Microsoft Office/Google Workspace.
• Ability to work independently in a fast-paced remote environment.
• Understanding of HIPAA regulations and patient confidentiality requirements.

Basic Requirements

• Must be proficient in speaking and writing English very clearly
• Must have relevant work experience
• Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory]
• Must be available for video meetings with your camera on (when needed)

Technical Requirements

• Device: Reliable laptop or desktop computer.
• Internet: High-speed connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Webcam for virtual meetings.
• Workspace: Quiet, professional environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.

Originally posted on Himalayas