New - Prior Authorization Specialist (Experience)- Remote

Prior Authorization Specialist – Remote Position Summary We’re looking for a driven, detail‑oriented individual to join our team as a Prior Authorization Specialist. You’ll receive training and ongoing support to set you up for success, along with a performance bonus incentive for high achievers. As part of this role, you’ll complete accurate insurance verifications and prior authorizations to ensure timely reimbursement. You’ll also collaborate with clinicians and insurance payors in a fast‑paced environment to manage claims, documentation, and approvals. If you enjoy problem‑solving, staying organized, and making a meaningful impact—both independently and as part of a team—we’d love to hear from you.

Key Responsibilities

• Medicaid, Medicare, Tricare, VA, and workers’ compensation claims.
• Review logs for accuracy and maintain detailed records in EMR/PM systems.
• Prepare appeal letters for denied claims
• Coordinate prior authorization processes including documentation, submission, and follow-up
• Communicate with providers and insurance companies regarding authorization status.
• Provide customer service support and assist patients with billing questions.
• Maintain HIPAA compliance and support daily revenue cycle operations.
• Perform additional administrative duties as assigned. Skills & Qualifications
• Rheumatology experience - Required
• Medication experience - Required
• Medication Prior Authorization experience Required
• 1–2 years of prior authorization experience or healthcare business office
• Knowledge of commercial insurance, Medicaid, Medicare, VA, Tricare, and workers’ compensation
• Proficient in EMR systems, Microsoft Word, Excel, Outlook, billing software, and medical terminology.
• Strong communication, problem-solving, and organizational skills.
• Detail-oriented, analytical, and able to multitask in a fast-paced environment.
• Experience in ICD-10 and utilization review . Education & Experience
• High School Diploma required; additional education in business or healthcare preferred.
• Experience in prior authorization, utilization review, insurance verification, and EMR systems. Work Environment & Physical Requirements
• Remote position
• Prolonged computer use; ability to lift up to 15 lbs. Job Type, Schedule & Compensation
• Full-time, Monday–Friday, 8-hour day shift.
• Pay: $21–$23 per hour, Training
• Training modules to increase skills
• Performance bonus incentives to increase compensation

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