medical/dental insurance and prior authorization verifier

(REMOTE) MEDICAL/DENTAL INSURANCE AND PRIOR AUTHORIZATION VERIFIER

Company: Teamficient -

Salary Range: TBD (Negotiable for highly experienced candidates)

Time Range: Between 7 AM – 7 PM CST (Graveyard Shift)

Working Hours: 9-hour shift (8 working hours + 1-hour break)

Days Off: TBD (2 days per week)

Why Join Teamficient?

• Competitive Salary with potential increases based on performance
• Full-Time Position (40 hours/week)
• Paid Training and opportunities for additional bonuses
• Government Contributions: SSS, PhilHealth, & PAG-IBIG
• Comprehensive Compensation: Holiday pay, overtime pay, night differential pay, & 13th-month pay
• Leave Credits & HMO after regularization

Job Overview

We are looking for a well-organized Medical/Dental Insurance and Prior Authorization Verifier to be involved in a wide range of support activities in our insurance and authorization department. You will also assist in creating policies, processes, and documents. Under this role, the Insurance and Prior Authorization Verifier will be working directly with one of our customers and delivering the tasks outlined in the responsibilities section – see below.

Key Responsibilities

• Verify patient insurance coverage, eligibility, and benefits prior to appointments and procedures.
• Conduct in-network and out-of-network checks across multiple U.S. insurance providers.
• Perform full insurance breakdowns (deductibles, copays, coinsurance, out-of-pocket maximums, coverage limitations, prior authorization requirements).
• Conduct eligibility checks using insurance portals and payer websites.
• Prepare and submit comprehensive prior authorization requests with required clinical documentation.
• Collaborate with healthcare providers to gather information and facilitate the authorization process.
• Monitor and follow up on prior authorization requests, maintaining detailed records of communications.
• Investigate and resolve insurance denials, including resubmissions and appeals when necessary.
• Communicate with insurance representatives to clarify coverage and resolve discrepancies.
• Communicate with patients regarding the authorization process, potential delays, and financial responsibilities.
• Document verification and authorization details accurately in the EMR/EHR or practice management system.
• Work with clinic staff to flag coverage issues and prevent claim denials.
• Ensure compliance with HIPAA, healthcare regulations, and insurance company policies.

Qualifications & Requirements

• Minimum 2 years of experience in U.S. healthcare insurance verification and/or prior authorization.
• Strong knowledge of major U.S. insurance carriers (Medicare, Medicaid, PPOs, HMOs, commercial plans).
• Proficiency in using insurance portals, clearinghouses, and EMR/EHR systems.
• Excellent English communication skills (written and verbal).
• Ability to confidently speak with insurance representatives and summarize findings clearly for providers.
• Detail-oriented, organized, and capable of managing high-volume verifications and authorizations daily.

Preferred Qualifications

• Experience handling complex prior authorizations, denials, and appeals.
• Prior work with multi-specialty practices or high-volume clinics.
• Familiarity with ICD-10, CPT coding, and medical necessity criteria.

Technical Requirements (Work-From-Home Setup)

• Computer: Minimum Intel Core i5, 8GB RAM (16GB preferred)
• Internet: Reliable connection (backup ISP required)
• Headset: USB noise-canceling headset
• Power Backup: UPS/generator or alternative work location in case of power outages
• Workspace: Quiet, distraction-free home office setup

This is a long-term opportunity to work with an experienced and supportive team in a fully remote setting while making a difference in the healthcare industry.

For inquiries, email: (Please note: Resumes sent directly to the HR email will not be entertained.)

Job Types: Full-time, Permanent

Work Location: Remote