Authorizations Specialist

4 days ago

Work from Home, Philippines The Perfect Child LLC Full time ₱900,000 - ₱1,200,000 per year

We are seeking a detail-oriented and dependable Authorizations Specialist to join our healthcare management team. The ideal candidate will be responsible for obtaining, tracking, and verifying insurance authorizations for medical services, ensuring timely approvals and compliance with payer requirements. This role is critical to supporting patient access to care and ensuring accurate and efficient operations within our clinical and administrative teams.

Key Responsibilities:

  • Review incoming service requests and determine if prior authorization is required based on insurance plan guidelines
  • Submit accurate and complete authorization requests to insurance companies, including all necessary documentation
  • Follow up with payers to ensure timely processing and communicate status updates to internal teams
  • Maintain detailed records of authorization approvals, denials, and pending cases
  • Coordinate with providers, clinicians, and patients to gather additional information as needed
  • Verify insurance coverage and eligibility for scheduled services
  • Respond to internal and external inquiries regarding authorization status and payer requirements
  • Escalate urgent or delayed cases to management for resolution
  • Stay current on payer policies, billing rules, and pre-certification procedures
  • Ensure HIPAA compliance and maintain confidentiality of patient information

Qualifications:

  • High school diploma or equivalent required; associate's or bachelor's degree preferred
  • 1–3 years of experience in medical authorizations, insurance verification, or healthcare administration
  • Strong understanding of commercial, Medicaid, and Medicare payer authorization processes
  • Familiarity with electronic health records (EHR) systems and payer portals
  • Excellent communication skills, both verbal and written
  • Strong attention to detail and organizational abilities
  • Ability to manage multiple tasks and meet tight deadlines
  • Proficiency in Microsoft Office (Word, Excel, Outlook)

Preferred Qualifications:

  • Experience in behavioral health, home health, or specialty care settings

Job Type: Full-time

Benefits:

  • Work from home

Work Location: Remote

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