Prior Authorization Specialist

2 weeks ago

Muntinlupa, Philippines MedCore Solutions Full time

Prior Authorization Specialist (Multi-Specialty) | Permanent WFH We are looking for an experienced Prior Authorization Specialist with a strong background in Pulmonology, Gastroenterology, and Internal Medicine. The ideal candidate will be responsible for obtaining timely prior authorizations, verifying insurance coverage, and ensuring accurate documentation to support smooth patient care delivery. Experience with NextGen software is highly preferred. Key Responsibilities: Process and track prior authorization requests for medications, procedures, and treatments. Verify patient insurance coverage, eligibility, and benefits. Collaborate with physicians, nurses, and insurance providers to obtain necessary approvals. Document and update all authorizations and communications in NextGen EMR. Identify and resolve prior authorization delays or denials in a timely manner. Maintain compliance with HIPAA and payer-specific guidelines. Requirements: Minimum 3 years of experience in prior authorization or medical billing/insurance verification. Strong knowledge in Pulmonology, Gastroenterology, and Internal Medicine workflows. Proficiency in NextGen software preferred. Familiarity with payer requirements and medical terminology. Excellent communication, organizational, and problem-solving skills. Ability to work independently in a fast-paced environment. Amenable to work during U.S. business working hours. Permanent Work From Home Why BizForce / MedCore Solutions? MedCore Solutions is the healthcare division of BizForce, dedicated to supporting U.S.-based healthcare clients through a skilled remote workforce in the Philippines. We specialize in connecting top clinical and administrative talent with reputable healthcare organizations, ensuring high-quality care delivery while providing rewarding work-from-home careers. Why work for Bizforce? Bizforce is a global remote workforce solutions company partnering with large Architectural and Engineering firms and healthcare clients. We aim to deliver dependable, high-quality skilled labor and business processes to US-based companies at affordable prices. Bizforce enables the best talent in PH to work remotely from home with the latest technology and resources, delivering qualified, professional workers and enabling strong career growth from home. Seniority level Associate Employment type Full-time Job function Health Care Provider Accounting/Auditing Finance Industries Hospitals and Health Care Financial Services Accounting Get notified about new Specialist jobs in Philippines. #J-18808-Ljbffr

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