Job details

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

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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

max

$50000K

$70000K

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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.