Prior Authorization Specialist (US Healthcare)

#1 PH Workforce Delivering to the US

MedCore Solutions, the healthcare division of Bizforce, is seeking a skilled Prior Authorization Specialist to join our growing team. The Prior Authorization Specialist we be primarily responsible for obtaining all types of prior authorizations. These prior authorizations will include biologic medications, procedures, prescriptions and out-patient testing. The position will require professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies and insurance carriers to accurately obtain the required information to process prior authorizations.

Responsibilities

• Review and process prior authorization requests for medical services, procedures, and medications
• Verify insurance (pharmacy) information and eligibility
• Handle patient inquiries regarding authorizations
• Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy.
• Accurately document all patient, pharmacy and insurance carrier interactions in EMR.
• Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
• Ensure accurate and timely documentation of authorization requests and approvals
• Collaborate with medical billing team to resolve any issues or denials
• Maintain up-to-date knowledge of insurance guidelines and procedures
• Complete other tasks as assigned by providers through EMR/EHR
• Copy, fax and mail documents and information as requested by insurance carrier
• Schedule follow-up appointments, biologic injections and photodynamic therapy treatments
• Assist pathology department with notifying patients of pathology results via telephone
• Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient’s rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
• Provide safe patient-centered, compassionate, and competent patient care.

Other details:

Start Date: TBD

Schedule: 8 hours/day Monday-Friday; 40 hours/week

Days Off: Saturday & Sunday

Time zone: TBD

Duration: Full-time

Requirements

• Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare

• Strong knowledge of insurance verification processes and payer/billing guidelines.
• Excellent communication and interpersonal skills to work effectively with patients, providers, and insurers.
• Detail-oriented with strong organizational skills
• Ability to work independently and meet deadlines
• Comfortable working in a remote, work-from-home setup
• Amenable to work in a graveyard shift

System Requirements

• Device (Desktop or Laptop)

1. Processor:

• Windows Devices: Intel Core i5 (or higher) or AMD Ryzen 5 (or higher).
• Mac Devices: Apple M1 chip or newer.

• Minimum of 8GB or higher for optimal performance.

• Windows: Windows 11 Pro (Windows 10 Pro is acceptable but not preferred). The operating system must have a legitimate license.
• Mac: macOS compatible with M1 or newer chips.

• At least an SSD for faster processing and performance.

• Minimum speed of 50 Mbps via a wired connection for stability and reliability.
• A backup internet connection is highly recommended.

• A backup power supply (e.g., UPS or generator) to prevent disruptions during power outages (optional but encouraged)

Benefits

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.

• Permanent Work From home
• Permanent Weekends Off
• Great Company Culture and No Micromanagement

Who We Are

MedCore Solutions (MCS) is a single source solution for Healthcare administration. MCS is an industry leader for medical billing, credentialing, scribing, insurance verification, compliance and virtual staffing.

We offer an expansive suite of administrative products and trainings to keep your practice and its employees safe and up to date with compliance and to avoid fines and litigation. Our online compliance center is quick and easy to use, and provides you with an extensive library of training courses, covering OSHA, HIPAA, Human Resources, Health Plan Management, Patient Safety and Regulations, Infection Control, and much more.