Prior Authorization Specialist

We are seeking a proactive and detail-oriented
Medical Prior Authorization Specialist
with at least
3 years of experience
to manage insurance approvals for medical procedures, treatments, and medications. The ideal candidate has hands-on experience supporting
Oculofacial Plastic and Reconstructive Surgery
practices and is comfortable navigating payer requirements using
DrChrono
. This role plays a critical part in ensuring patients receive timely access to care—no delays, no chaos.

Key Responsibilities

• Review medical records, clinical notes, and physician orders to determine prior authorization requirements
• Submit prior authorization requests through insurance portals, phone, and fax with accuracy and efficiency
• Track, follow up, and expedite pending authorizations, including urgent and time-sensitive cases
• Communicate authorization statuses clearly with providers, clinical staff, scheduling teams, and patients
• Manage and submit appeals for denied authorizations, including compiling additional clinical documentation
• Maintain accurate and detailed records of all authorization activities and outcomes
• Stay up to date on payer policies, coverage guidelines, and authorization workflows
• Coordinate closely with clinical teams to ensure medical necessity documentation is complete and compliant

Qualifications

• High school diploma or equivalent required; associate degree or healthcare-related certification preferred
• Minimum of 3 years of experience in medical prior authorizations or related healthcare administrative roles
• Direct experience supporting Oculofacial Plastic and Reconstructive Surgery strongly preferred
• Hands-on experience using DrChrono EHR required
• Solid understanding of medical terminology, CPT, ICD-10 codes, and insurance processes
• Strong organizational skills with the ability to manage multiple authorizations simultaneously
• Excellent verbal and written communication skills
• Proficiency with EHR systems and insurance payer portals
• Patient-focused, detail-driven, and solution-oriented (you get things done)

Work-from-Home Device Requirement

• Device: Personal computer with Intel Core i5 or higher, or AMD Ryzen 5 or higher
• Internet: Wired connection with at least 50 Mbps download speed, plus a backup connection (e.g., mobile hotspot or prepaid Wi-Fi)
• Work Environment: Quiet, well-lit space with minimal background noise

Benefits

• Permanent Work From Home
• Weekly Paychecks
• Fixed Weekends Off
• HMO Reimbursement on your 90th day
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary

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Who are we?
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 currently partnering with some of the largest Architectural and Engineering firms in the world. If you are looking to advance your career and improve your skills with an industry leader, we encourage you to apply today Bizforce was founded with one goal – to deliver dependable high-quality skilled labor and business processes to US-based companies at affordable prices. Bizforce has grown rapidly and allows the best talent in PH to work remotely from home with the latest technology and resources. BizForce is proud to partner with PH to deliver qualified, professional workers, giving our Architects and Engineers the ability to have an unbeatable career and work from home.