Bilingual Prior Authorization, Insurance Verification Specialist

• Verify patient insurance eligibility, active coverage, benefits, effective dates, plan type, network status, copays, deductibles, coinsurance, out-of-pocket information, referral requirements, and authorization requirements
• Document eligibility and benefit information in EZ Derm or the designated workflow
• Communicate with insurance companies about eligibility, benefits, authorization requirements, and pending requests
• Document insurance calls, including representative name, reference number, date and time, phone number, information obtained, and next action
• Manage prior authorizations from submission through final resolution
• Submit prior authorization requests with complete supporting documentation
• Track status updates, additional information requests, approvals, denials, authorization numbers, approved codes, units, and date ranges
• Manage prior authorizations for biologic medications
• Create and maintain follow-up tasks for unresolved insurance and authorization items
• Track pending items through completion, resolution, or escalation
• Escalate clinical, financial, missing information, denial, delay, or decision-making concerns as appropriate
• Handle insurance-related phone calls as the primary focus
• Provide overflow patient call support as operational needs allow
• Provide a daily End of Day report summarizing completed work and outstanding items
• Maintain patient confidentiality and comply with HIPAA and practice policies
• Use EZ Derm, 3CX, insurance portals, payer systems, task workflows, phone, email, and internal communication systems

• Prior experience in a healthcare or medical practice setting
• Fluency in both English and Spanish
• Hands-on experience verifying insurance eligibility, benefits, coverage, plan details, and authorization requirements
• Experience managing prior authorizations from submission through resolution
• Experience speaking directly with insurance representatives by phone
• Experience maintaining detailed records, creating follow-up tasks, tracking pending authorizations, and following unresolved items through completion
• Must speak and write English clearly and professionally
• Relevant work experience
• Must provide an NBI Clearance and/or Local Police Clearance before onboarding
• Must be available to attend video meetings with camera on when required
• Reliable laptop or desktop computer
• Stable high-speed internet connection of at least 25 Mbps
• Noise-canceling headset
• Working webcam
• Quiet and professional work environment
• Biologic medication prior authorization experience strongly preferred
• EZ Derm experience preferred but not required
• 3CX or similar business phone system experience preferred but not required

• Dedicated HR & Contractor Support Team
• Premium VPN Access (Optional)
• HIPAA & Cybersecurity Training + Certification (Provided)
• Top 1% VA Performance Training
• Client-Approved U.S. Holidays
• Client-Approved Paid or Unpaid Time Off
• Access to Tools & Resources
• Optional Performance-Based Incentives