Prior Authorization Specialist

Job Title: Prior Authorization Specialist (US Healthcare | Remote)

Eastern Time (US) – Monday to Friday (08:00 AM TO 05:00 PM)

Must be willing to work graveyard shift (PH time)

We are seeking a highly experienced Prior Authorization Specialist who can independently manage the end-to-end prior authorization process for a US-based healthcare practice.

The ideal candidate must be confident in handling high-volume submissions and able to complete at least 25–30 cases per day accurately and efficiently.


Key Responsibilities (End-to-End Process)

-Verify patient insurance eligibility and benefits

-Review provider orders and clinical documentation

-Submit prior authorization requests via portal, fax, or phone

-Upload required medical records

-Follow up with insurance companies for status updates

-Handle approvals, denials, and appeals

-Communicate status updates to providers and the internal team

-Document all actions accurately in EMR/EHR systems

-Ensure HIPAA compliance at all times.

Qualifications:

-Minimum of 1 year of Prior Authorization experience in a Pain Management setting.

-Strong knowledge of commercial insurance, Medicare, Medicaid, and workers' compensation authorization processes.

-Experience obtaining authorizations for pain management procedures, injections, imaging studies, and related treatments.

-Ability to track authorization status, follow up with insurance payers, and resolve denials.

-Familiarity with EMR/EHR systems and medical billing workflows.

-Excellent communication and organizational skills.

-Ability to work independently in a remote environment.

Preferred:

-Experience with interventional pain management procedures.

-Knowledge of CPT, ICD-10, and HCPCS coding related to pain management services.



Technical Requirements:

-Stable high-speed internet (minimum 70 Mbps)

-Noise-canceling headset

-Quiet home office setup

-Backup internet and power source preferred.


How to Apply:

We kindly ask that you send the following:

-Updated resume

-Summary of your end-to-end PA experience

-Average number of cases you handle daily

-EMR systems you have used

-Internet speed test result

Please send me a message here in my inbox (attach your cv) so we can proceed to the next step.

Thank you