Prior Authorization Specialist (US Healthcare) - Work from Home

#1 PH Workforce Delivering to the US

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

Other details:

Start Date: TBD

Schedule: 8 hours/day Monday-Friday; 40 hours/week

Days Off: Saturday & Sunday

Time zone: TBD

Duration: Full-time

Requirements

• 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
• Well-versed in
• 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

Benefits

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.

• Permanent Work From home
• Permanent Weekends Off
• Great Company Culture and No Micromanagement
• Continued Education
• Specialized Training

Who We Are

MedCore Solutions (MCS) is a single source solution for Healthcare administration. MCS is an industry leader for medical billing, credentialing, scribing, insurance verification, compliance and virtual staffing.

We offer an expansive suite of administrative products and trainings to keep your practice and its employees safe and up to date with compliance and to avoid fines and litigation. Our online compliance center is quick and easy to use, and provides you with an extensive library of training courses, covering OSHA, HIPAA, Human Resources, Health Plan Management, Patient Safety and Regulations, Infection Control, and much more.