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Prior Authorization Specialist (Orthopedic) | Permanent WFH image - Rise Careers
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Prior Authorization Specialist (Orthopedic) | Permanent WFH

MedCore Solutions, the healthcare division of Bizforce, is seeking a skilled Prior Authorization Specialist to join our growing team. The Prior Authorization Specialist we be primarily responsible for obtaining all types of prior authorizations. These prior authorizations will include biologic medications, procedures, prescriptions and out-patient testing. The position will require professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies and insurance carriers to accurately obtain the required information to process prior authorizations.

Responsibilities:

  • Review and process prior authorization requests for medical services, procedures, and medications
  • Verify insurance (pharmacy) information and eligibility
  • Handle patient inquiries regarding authorizations
  • Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy.
  • Accurately document all patient, pharmacy and insurance carrier interactions in EMR.
  • Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
  • Ensure accurate and timely documentation of authorization requests and approvals
  • Collaborate with medical billing team to resolve any issues or denials
  • Maintain up-to-date knowledge of insurance guidelines and procedures
  • Complete other tasks as assigned by providers through EMR/EHR
  • Copy, fax and mail documents and information as requested by insurance carrier
  • Schedule follow-up appointments, biologic injections and photodynamic therapy treatments
  • Assist pathology department with notifying patients of pathology results via telephone
  • Fulfill organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient’s rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
  • Provide safe patient-centered, compassionate, and competent care
  • Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
  • Strong understanding of medical billing and insurance processes
  • Excellent communication and interpersonal skills
  • Detail-oriented with strong organizational skills
  • Ability to work independently and meet deadlines
  • Comfortable working in a remote, work-from-home setup
  • Average English communication skills
  • Amenable to work in a graveyard shift

System Requirements

  • Own Desktop/Laptop
  • Computer Processor: Intel I3/AMD Ryzen 3/MAC Intel I5
  • RAM: At least 4GB of RAM (8GB is recommended) with sufficient hard disk space available
  • Internet Connectivity: At least 20-25 Mbps and up wired Internet Connection
  • Back-up Connections & Power Supply: USB sticks, hotspots, signal-based & wireless connections only for back-up
  • Permanent Work From Home
  • Leave Credits
  • Monetary Allowance
  • Annual Bonus
  • Weekly Paychecks
  • Fixed Weekends Off
  • Thriving Company Culture with Complete Autonomy
  • Exclusive Specialized Training Programs
  • Unlock Your Potential with a Highly Competitive Salary

____________________________________________________________________

Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.

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.

Average salary estimate

$60000 / YEARLY (est.)
min
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$50000K
$70000K

If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.

What You Should Know About Prior Authorization Specialist (Orthopedic) | Permanent WFH, BizForce

MedCore Solutions, the healthcare division of Bizforce, is on the lookout for a dedicated Prior Authorization Specialist to join our dynamic team. In this role, you'll be responsible for navigating the intricate world of prior authorizations, ensuring that biologic medications, procedures, prescriptions, and outpatient testing are processed accurately and efficiently. You'll collaborate with patients, healthcare providers, and insurance companies, helping to streamline the process and remove barriers to care. With your excellent communication skills, you will handle patient inquiries, verify insurance eligibility, and ensure that all documentation is complete and flawless before submission. Your attention to detail will shine as you work tirelessly to document all interactions in our electronic medical record (EMR) system, ensuring compliance and efficiency in our operations. This role is fully remote, allowing you to enjoy a flexible work environment while upholding our commitment to safe, patient-centered care. If you have 3-5 years of experience as a Prior Authorization Specialist in the US healthcare sector, a solid understanding of medical billing processes, and a passion for helping others, we want to hear from you! At Bizforce, we value our team and provide a thriving culture, with exclusive training programs and competitive salaries, ensuring you have everything you need to unlock your potential in this rewarding role.

Frequently Asked Questions (FAQs) for Prior Authorization Specialist (Orthopedic) | Permanent WFH Role at BizForce
What are the main responsibilities of a Prior Authorization Specialist at MedCore Solutions?

As a Prior Authorization Specialist at MedCore Solutions, your primary responsibilities will include reviewing and processing prior authorization requests for various medical services and medications. You will also verify insurance information, handle patient inquiries, and ensure that all required documentation is accurate and complete. Moreover, you will coordinate with healthcare providers and insurance companies to facilitate the authorization process.

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What qualifications do I need to apply for the Prior Authorization Specialist position at MedCore Solutions?

To apply for the Prior Authorization Specialist position at MedCore Solutions, you should have 3-5 years of experience in a similar role within the US healthcare system. A strong understanding of medical billing and insurance processes is essential, along with excellent communication and organizational skills. Candidates should also feel comfortable working independently in a remote setting.

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Is remote work an option for the Prior Authorization Specialist role at MedCore Solutions?

Yes, the Prior Authorization Specialist position at MedCore Solutions is a permanent work-from-home opportunity. This remote setup allows you to enjoy a flexible work environment while still contributing to a dedicated and professional team. It is an ideal setup if you thrive in a remote work culture.

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What does the work environment look like for a Prior Authorization Specialist at MedCore Solutions?

The work environment for a Prior Authorization Specialist at MedCore Solutions is supportive and focused on collaboration. You'll work with a talented team from the comfort of your own home, utilizing cutting-edge technology to ensure seamless communication with patients, providers, and insurance representatives. With a thriving company culture that values employee well-being, you will find a rewarding atmosphere to grow and succeed in your career.

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What benefits can a Prior Authorization Specialist expect while working at MedCore Solutions?

As a Prior Authorization Specialist at MedCore Solutions, you can expect a variety of benefits, including leave credits, monetary allowances, annual bonuses, and a highly competitive salary. The company also emphasizes professional growth and offers exclusive specialized training programs to help you advance your skills while maintaining work-life balance with fixed weekends off.

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Common Interview Questions for Prior Authorization Specialist (Orthopedic) | Permanent WFH
What strategies do you use to manage the prior authorization process?

When answering this question, outline your approach to handling prior authorizations efficiently, mentioning strategies such as organizing information by priority, maintaining meticulous documentation, and leveraging strong communication skills to collaborate with involved parties.

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Can you describe a challenging situation you faced while processing a prior authorization?

Provide a specific example of a challenge you encountered, such as a denial from an insurance company, and explain how you resolved it. Highlight your problem-solving abilities and your commitment to advocacy for patient care.

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What experience do you have with electronic medical record (EMR) systems?

Share your previous experience with EMR systems, detailing the platforms you've worked with and how you've utilized them to enhance your efficiency in managing prior authorizations and maintaining accurate records.

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How do you ensure accurate documentation in your authorization requests?

Discuss your attention to detail and your systematic approach to documenting every interaction and approval accurately to avoid errors. Emphasize the importance of double-checking forms before submission.

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How do you stay current with insurance guidelines and policies?

Explain the methods you use to keep up with changing insurance guidelines, such as attending training, webinars, or subscribing to relevant professional organizations.

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How do you handle difficult conversations with patients about rejections or denials?

Describe your communication style and how you approach sensitive conversations with empathy and professionalism, making sure to guide the patient through their options.

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What motivates you to work in the healthcare industry?

Share your passion for helping others and the value you place on improving patient outcomes. Relate your motivation to the position of Prior Authorization Specialist and how it aligns with your career goals.

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What software tools do you find most useful in your role?

Talk about the specific software tools you've used in previous roles, focusing on their functionality and how they've helped you manage your workflow efficiently in prior authorization tasks.

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Describe your experience with insurance verification.

Provide an overview of your background in insurance verification, touching on the processes you've followed and the types of information you verify to ensure accurate prior authorizations.

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How would you prioritize your tasks in a busy work environment?

Discuss your time management skills and how you prioritize tasks based on urgency and importance. Provide examples of how you have successfully balanced multiple responsibilities in fast-paced settings.

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DATE POSTED
December 18, 2024

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