Prior Authorization Specialist

3 days ago

Manila, National Capital Region, Philippines BizForce Full time

We're looking for an experienced Authorization Specialist who knows the ins and outs of obtaining approvals for pain management services. If you've spent at least three years navigating prior auths, insurance requirements, and payer quirks—especially within
Greenway
—this role is right up your alley. You'll help keep patient care running smoothly by securing timely authorizations and preventing delays or denials.

Key Responsibilities

  • Obtain prior authorizations for pain management procedures, diagnostic imaging, and medications according to payer-specific policies.
  • Verify patient insurance eligibility and benefits before appointments or procedures are scheduled.
  • Review provider notes and supporting documentation to confirm medical necessity and submit complete, accurate requests.
  • Communicate with insurance companies to resolve issues, clarify requirements, and speed up approval turnaround times.
  • Track, manage, and follow up on pending authorizations to ensure continuity of care and avoid treatment delays.
  • Maintain detailed records of all authorization activities—approvals, denials, documentation, and correspondence—within Greenway EHR.
  • Work closely with scheduling, clinical, and billing teams to reduce claim denials and ensure smooth workflow across departments.

Qualifications

  • 3+ years of experience securing prior authorizations in a healthcare setting, preferably within pain management.
  • Strong knowledge of insurance guidelines, medical necessity requirements, and payer policies.
  • Proficiency with Greenway or similar EHR/PM systems.
  • Excellent communication skills with the ability to collaborate across teams and speak confidently with insurance representatives.
  • Strong attention to detail, accuracy, and follow-through.
  • Ability to multitask and manage high-volume authorization requests efficiently.

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

____________________________________________________________________

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.

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