Prior Authorization Specialist

Job Title: Prior Authorization Specialist

Job Code: [JW-BODB]

Position Type: Full-time

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

Salary rate: $5-$7per hour

Key Responsibilities

• Gather clinical documentation, confirm medical necessity criteria, submit requests via payer portals (e.g., Availity), CoverMyMeds, fax, or phone.
• Monitor status queues daily, follow up within payer timelines, and manage renewals/reauthorizations proactively.
• Verify eligibility and benefits through online portals, clearinghouses, and outbound payer calls.

• Confirm and document: copays, deductibles, coinsurance, OOP max, plan type, effective dates, coverage limitations, and authorization/referral requirements.
• Flag and resolve discrepancies (inactive coverage, wrong member ID, plan mismatches) before service dates to prevent denials.
• Review EOB/ERA/denial messages, identify root cause (eligibility, auth, coding, medical necessity, timely filing, documentation, referral).
• Coordinate corrections, resubmissions, peer-to-peer requests, and formal appeals as needed.

Requirements:
Experience Requirements:

• Healthcare-related education or experience (nursing, pharmacy, medical admin, billing, etc.)
• 1–2+ years experience in prior authorizations, medical billing, pharmacy coordination, or insurance verification
• Comfortable with insurance portals and payer processes (e.g., Availity, CoverMyMeds) and EHR systems
• Knowledge of eligibility/benefits and denials/appeals workflows
• Strong communication, organization, and attention to detail
• Able to work independently in a fast-paced setting
• Follows HIPAA, payer rules, and protects patient confidentiality

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 10 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, trainings, or allowances listed are optional contractor perks and not employee benefits.