Medical VA – Prior Authorization Specialist

• Manage the end-to-end prior authorization process for healthcare practitioners.
• Submit, track, and follow up on prior authorization requests.
• Manage inbound and outbound calls with healthcare insurance companies to verify authorization requirements, check status updates, and resolve pending or denied requests.
• Verify patient healthcare insurance coverage, benefits, and plan requirements before scheduling procedures or submitting authorizations.
• Retrieve relevant medical history, clinical notes, and diagnostic reports.
• Act as the primary point of contact between medical providers, patients, and payors.
• Identify reasons for authorization denials, gather missing clinical information, and prepare basic appeal packages under healthcare provider direction.
• Provide back-office support including data entry, email management, authorization tracking log maintenance, and record management.
• Ensure timely approvals for procedures, medications, diagnostic testing, and specialist referrals.
• Support patient care access, practice workflow, and revenue cycle efficiency.

• Minimum of 6 months to 1 year of prior authorization or healthcare BPO experience handling US healthcare accounts.
• Strong familiarity with insurance portals, EMR/EHR systems, and medical terminology.
• HIPAA Certification is a plus
• Excellent time management
• Strong attention to detail
• Computer savvy
• Great work attitude and willingness to go the extra mile
• Open to working night shifts
• Primary computer: Intel Core i5-6000 (6th Gen or higher) or AMD Ryzen 5 or higher
• Primary computer memory/RAM: 8.00 GB
• Primary operating system: at least Windows 11 64-bit or macOS Ventura
• USB headset with noise-cancelling feature
• Camera capable of clear and crisp video output
• Required backup system or UPS capable of supporting the workstation for at least 3 hours; typically 240Wh or higher
• UPS must accept all plugs required for the primary device and work environment
• Primary DSL/fiber internet connection with minimum 100mb/s contracted
• Backup internet connection with minimum 20mb/s (cell)
• Must adhere to HIPAA regulations and maintain confidentiality of patient data, insurance details, and communications

• Starting rate is $800 (USD) monthly
• Free Training
• Paid Time Offs
• HMO Coverage
• Optical Rewards
• Performance-Based Increase
• Permanent Work From Home