prior authorization specialist

CareMed Specialty Pharmacy

<div><div><div>Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy 
Waltham, MA | Full-Time | Starting at $23.00/hr and up</div>
<div></div><div>Sign-On Bonus: $5,000 for employees starting before July 31, 2026.</div>
<div></div><div>Join a mission-driven team making a difference in the lives of cancer and rare disease patients.</div>
<div></div><div>CareMed Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Waltham, MA. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.</div>
<div></div><div>Company Benefits</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Quarterly Incentive Bonus</li>
<li>Paid Volunteer Day</li>
<li>Referral Incentive Program</li>
<li>Company Paid Life Insurance; and Short/Long-Term Disability</li>
</ul> <div>Why Join Us?</div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value teamwork, respect, integrity, and passion.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul><div>What You&rsquo;ll Do</div>
<div>The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.</div>
<div></div><div>How You&rsquo;ll Do This</div>
<ul><li>Manage prior authorization requests and appeals with insurance carriers.</li>
<li>Collaborate with physicians, pharmacists, and other departments.</li>
<li>Ensure HIPAA compliance while handling sensitive patient information.</li>
<li>Maintain accurate documentation of authorization details.</li>
<li>Proactively monitor and renew expiring authorizations.</li>
</ul> <div>What You Bring</div>
<div>Required:</div>
<ul><li>High School Diploma or GED</li>
<li>1+ years of pharmacy or prior authorization experience</li>
<li>Registration with Board of Pharmacy (as required by state law)</li>
<li>Strong communication, organizational, and customer service skills</li>
<li>Self-motivated, organized, detail-oriented, and adaptable to changing priorities</li>
<li>Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds</li>
</ul><div>Preferred:</div>
<ul><li>Associate degree or Certified Pharmacy Technician (PTCB)</li>
<li>3+ years of experience in pharmacy or prior authorizations</li>
<li>Specialty pharmacy experience</li>
</ul><div>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</div></div></div>

Prior Authorization Specialist

<div>
 
 Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy
 
 
 
 
 Houston, TX
 
 |
 
 Full-Time
 
 |
 
 Starting at $23.00/hr and up
 
 
 
 
 Sign-On Bonus:
 
 $5,000 for employees starting before July 31, 2026.
 
 
 
 Join a mission-driven team making a difference in the lives of cancer patients.
 
 
 
 CareMed Specialty Pharmacy is seeking a
 
 Pharmacy Prior Authorization Specialist
 
 to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area.
 
 Remote work possible after initial on-site training.
 
 
 
 
 Company Benefits
 
 
 
 <ul>
 <li>
 Medical; Dental; Vision
 </li>
 <li>
 401k with a match
 </li>
 <li>
 Paid Time Off and Paid Holidays
 </li>
 <li>
 Tuition Reimbursement
 </li>
 <li>
 Quarterly Incentive Bonus
 </li>
 <li>
 Paid Volunteer Day
 </li>
 <li>
 Referral Incentive Program
 </li>
 <li>
 Company Paid Life Insurance; and Short/Long-Term Disability
 
 
 </li>
 </ul>
 
 Why Join Us?
 
 
 
 <ul>
 <li>
 A career with purpose: Help patients access life-saving medications.
 </li>
 <li>
 Supportive culture: We value teamwork, respect, integrity, and passion.
 </li>
 <li>
 Growth opportunities: We invest in your professional and personal development.
 
 
 </li>
 </ul>
 
 What You&rsquo;ll Do
 
 
 
 The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
 
 
 
 How You&rsquo;ll Do This
 
 
 
 <ul>
 <li>
 Manage prior authorization requests and appeals with insurance carriers.
 </li>
 <li>
 Collaborate with physicians, pharmacists, and other departments.
 </li>
 <li>
 Ensure HIPAA compliance while handling sensitive patient information.
 </li>
 <li>
 Maintain accurate documentation of authorization details.
 </li>
 <li>
 Proactively monitor and renew expiring authorizations.
 
 
 </li>
 </ul>
 
 Required
 
 
 
 
 What You Bring
 
 
 
 <ul>
 <li>
 High School Diploma or GED
 </li>
 <li>
 1+ years of pharmacy or prior authorization experience
 </li>
 <li>
 Registration with Board of Pharmacy (as required by state law)
 </li>
 <li>
 Strong communication, organizational, and customer service skills
 </li>
 <li>
 Self-motivated, organized, detail-oriented, and adaptable to changing priorities
 </li>
 <li>
 Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
 
 
 </li>
 </ul>
 
 Preferred
 
 
 
 <ul>
 <li>
 Associate degree or Certified Pharmacy Technician (PTCB)
 </li>
 <li>
 3+ years of experience in pharmacy or prior authorizations
 </li>
 <li>
 Specialty pharmacy experience
 
 
 </li>
 </ul>
 
 Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.
 
 
 
 
 Company Values: Teamwork, Respect, Integrity, Passion
 
</div>

VCU Health System

<div>**Remote to Virginia ONLY! Must have active VA Pharmacy and PTCB license in good standing** 
 
The Reimbursement Specialist Supervisor oversees the daily operations of the Reimbursement Specialist team to ensure timely and accurate processing of prior authorizations, insurance follow-ups, and patient assistance program requests pertaining to high-cost medications that require prior authorization. This role provides guidance, coaching, and performance management for team members, while supporting workflow optimization and departmental revenue collection goals.
Essential Job Statements<ul><li>
Supervise, coordinate, and prioritize the workflow of Reimbursement Specialists across multiple clinics.</li><li>
Provide direct line supervision for Reimbursement Specialists, including performance evaluations, disciplinary action, time/attendance, coordination of staff activities, or other work as needed. Conduct hiring, interviewing, onboarding, and training of new employees.</li><li>
Monitor team productivity and compliance with turnaround times, providing feedback and coaching as needed.</li><li>
Facilitate training and onboarding of new Reimbursement Specialists.</li><li>
Review complex or escalated prior authorizations and appeals, ensuring appropriate documentation and</li><li>
compliance with insurance and regulatory requirements.</li><li>
Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure patients receive timely access to medications.</li><li>
Identify process improvements to optimize team efficiency and patient care outcomes.</li><li>
Prepare and review reports on team performance, Patient Assistance (PA) approvals/denials, and workload metrics.</li><li>
Ensure compliance with departmental and health system policies and regulatory requirements.</li><li>
Participate in special projects and cross-functional initiatives as assigned.</li><li>
Serve as a point of contact for internal and external escalations related to PAs, appeals, or patient access concerns.</li><li>
Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the Department. Provides assistance to team members. Accepts alternate assignments, as required.</li></ul>
Patient Population
Not applicable to this position.
Employment Qualifications
Required Education:
High School Diploma or equivalent
Preferred Education:
Associate&rsquo;s Degree or higher in Business, Healthcare Administration, or related field
Licensure/Certification Required:
Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of Pharmacy
Licensure/Certification Preferred:
Additional supervisory or leadership certifications a plus
Minimum Qualifications
Years and Type of Required Experience &middot;
Minimum of three (3) years of experience as a Reimbursement Specialist or equivalent role
Previous experience supervising or mentoring staff
Other Knowledge, Skills and Abilities Required:
Strong knowledge of PAPs, prior authorizations, and insurance benefit investigations
Proficiency in EMR systems and Microsoft Office
Cultural Responsiveness
Other Knowledge, Skills and Abilities Preferred:
Strong leadership and communication skills
Ability to handle multiple priorities and high-volume workload
Working Conditions
Periods of high stress and fluctuating workloads may occur.
General office environment.
May be exposed to high noise levels and bright lights.
May have periods of constant interruptions.
Prolonged periods of working alone.
Physical Requirements
Physical Demands: Lifting/ Carrying (0-50 lbs.), Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near
Hazards:
Mental/Sensory &ndash; Emotional
Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking
Emotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran</div>

Reimbursement Specialist Supervisor - Remote

Corazon Imaging

Full-Time | Hybrid: 3 Days In-Office / 2 Days RemoteAbout Corazon ImagingCorazon Imaging is the leading outpatient provider of coronary CT angiography, or CCTA, in the United States. Corazon is focused on expanding access to advanced, non-invasive cardiac imaging that helps physicians identify coronary artery disease earlier, improve patient care, and support better clinical decision-making.As Corazon continues to grow nationally, we are seeking a highly organized, detail-oriented Cardiac CT Reporting Operations Specialist to support the timely completion, quality control, combination, and distribution of cardiac CT imaging reports.General SummaryThe Cardiac CT Reporting Operations Specialist will manage the operational workflow for CCTA reporting, including tracking report turnaround times, coordinating the completion and combination of CCTA, FFR-CT, AI-plaque analysis, and extracardiac overread reports, and ensuring final reports are accurately distributed to ordering providers and appropriate recipients.This role will also support the creation and submission of templated letters of medical necessity, respond to medical records requests, and help ensure that Corazon&rsquo;s reporting operations are timely, complete, compliant, and provider-focused.This is an ideal role for someone with a background in radiology operations, cardiology practice operations, medical records, health information management, prior authorization, imaging center administration, or clinical documentation support.Essential Duties: CCTA Reporting Workflow Management<ul><li>Monitor all CCTA cases from image acquisition through final report completion and distribution.</li><li>Track report turnaround time and identify cases at risk of delay.</li><li>Communicate with physicians, radiologists, reading teams, and internal operations staff to ensure reports are completed within expected timeframes.</li><li>Maintain daily reporting worklists and case-status trackers.</li><li>Escalate delayed, incomplete, or missing reports to appropriate leadership.</li><li>Support Corazon&rsquo;s commitment to timely, accurate, and complete cardiac CT reporting.</li><li>Perform other duties as assigned.</li></ul>Report Combination and Finalization<ul><li>Coordinate and combine multiple report components into a complete final reporting package, including:</li><li>CCTA report</li><li>FFR-CT report, when applicable</li><li>AI-plaque analysis report, when applicable</li><li>Extracardiac overread report</li><li>Ensure all applicable report components are present before final distribution.</li><li>Review reports for completeness, formatting consistency, correct patient identifiers, correct ordering provider information, and appropriate attachment of supporting documentation.</li><li>Confirm that revised or addended reports are properly tracked and redistributed when necessary.</li></ul>Report Distribution<ul><li>Distribute finalized reports to ordering physicians, referring practices, and other approved recipients through approved channels.</li><li>Ensure reports are submitted to the correct practice, provider, fax number, portal, or electronic medical record destination.</li><li>Maintain accurate documentation of report delivery and confirmation when required.</li><li>Assist with provider office follow-up when reports are missing, delayed, or need to be resent.</li><li>Support excellent communication with referring provider offices.</li></ul>Letters of Medical Necessity and Documentation Support<ul><li>Prepare templated letters of medical necessity using approved Corazon templates.</li><li>Ensure letters are completed accurately using case-specific information, payer requirements, and supporting clinical documentation.</li><li>Coordinate with internal teams to obtain missing information needed for letters or appeals.</li><li>Maintain organized records of submitted letters and related documentation.</li><li>Support prior authorization, appeal, and medical necessity workflows as needed.</li></ul>Medical Records Requests<ul><li>Processing medical records requests in accordance with company policy and HIPAA requirements.</li><li>Verify requestor authorization and ensure records are released only to appropriate parties.</li><li>Gather and send requested imaging reports, supporting documentation, and related records.</li><li>Track completion of medical records requests and maintain proper documentation.</li><li>Work with internal teams to resolve incomplete, unclear, or urgent records requests.</li></ul>Quality Control and Compliance<ul><li>Ensure all reporting and records workflows are completed in a HIPAA-compliant manner.</li><li>Protect patient confidentiality and sensitive health information at all times.</li><li>Identify workflow gaps, recurring delays, or documentation issues and escalate appropriately.</li><li>Help maintain standard operating procedures for report tracking, report distribution, letters of medical necessity, and medical records requests.</li><li>Participate in process improvement initiatives to improve turnaround time, reporting accuracy, and provider satisfaction.</li></ul>Required Qualifications<ul><li>Minimum of 2&ndash;4 years of experience in a healthcare administrative, radiology, cardiology, medical records, prior authorization, or clinical documentation role.</li><li>Strong understanding of HIPAA and patient privacy requirements.</li><li>Experience working with medical records, physician reports, clinical documentation, or imaging reports.</li><li>Strong attention to detail and ability to manage multiple time-sensitive cases at once.</li><li>Excellent written and verbal communication skills.</li><li>Comfortable communicating with physicians, radiologists, provider offices, patients, and internal team members.</li><li>Strong organizational skills and ability to maintain accurate tracking systems.</li><li>Proficiency with Microsoft Office, Google Workspace, EMR systems, fax platforms, portals, or similar healthcare workflow tools.</li><li>Ability to work independently in a hybrid environment while remaining accountable to daily deadlines.</li></ul>Preferred Qualifications<ul><li>Experience in radiology, cardiology, outpatient imaging, hospital imaging, or diagnostic testing operations.</li><li>Familiarity with coronary CTA, cardiac imaging, CT imaging, or advanced imaging workflows.</li><li>Experience with PACS, RIS, EMR, medical records platforms, or provider portal systems.</li><li>Prior experience preparing or supporting letters of medical necessity, prior authorization documentation, or payer appeals.</li><li>Associate&rsquo;s or bachelor&rsquo;s degree in healthcare administration, health information management, business, or a related field preferred.</li><li>RHIT, RHIA, CPC, CMA, medical assistant, LPN, radiology assistant, or similar healthcare credential helpful but not required.</li></ul>Ideal Candidate BackgroundThe ideal candidate does not need to be a clinician, but should have meaningful experience in a healthcare environment where accuracy, timeliness, documentation, and patient confidentiality are critical.Strong candidates may come from backgrounds such as:<ul><li>Radiology reporting coordinator</li><li>Imaging center operations coordinator</li><li>Cardiology practice coordinator</li><li>Medical records specialist</li><li>Health information management specialist</li><li>Prior authorization or appeals specialist</li><li>Clinical documentation coordinator</li><li>Physician practice operations specialist</li><li>Medical assistant with strong administrative and documentation experience</li><li>PACS/RIS or imaging workflow support specialist</li></ul>This role is best suited for someone who is highly reliable, detail-driven, comfortable with medical terminology, and able to manage multiple moving parts in a fast-paced clinical operations environment.Schedule and Work Environment<ul><li>Full-time position.</li><li>Hybrid schedule: three days per week in office and two days per week remote.</li><li>Standard business hours, with occasional flexibility required based on reporting volume or urgent provider needs.</li><li>Office-based collaboration with clinical operations, reporting, provider relations, billing, authorization, and medical leadership teams.</li></ul>Compensation and Benefits<ul><li>Annual salary range: $55,000&ndash;$65,000, based on experience and qualifications.</li><li>Health insurance.</li><li>Paid time off.</li><li>401(k) with company match.</li><li>Additional benefits available based on company policy.</li></ul>Why Join Corazon ImagingCorazon Imaging is at the forefront of outpatient coronary CTA and advanced cardiac imaging. This role offers the opportunity to be part of a growing national organization that is improving access to high-quality cardiac imaging and supporting physicians in the early detection of coronary artery disease.The Cardiac CT Reporting Operations Specialist will play a key role in ensuring that providers receive accurate, complete, and timely reports that directly support patient care.Pay: $55,000.00 - $65,000.00 per yearBenefits:<ul><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Paid time off</li></ul>Work Location: Hybrid remote in Southfield, MI 48076

Cardiac CT Reporting Operations Specialist

Amerita

<div>Our Company:
<div>
Amerita</div><div></div>
Overview:
<div>Amerita is hiring a Benefits Investigation Specialist for a remote role.</div><div>
Join our home infusion team This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow-up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process. Apply today and become part of a team committed to making a difference!</div><div>
</div><div>
Schedule:</div><div>
Monday - Friday 9:30am - 6:30pm CST</div><div>
</div><div>
Benefits and perks for you!</div><div>
Medical, Dental, Vision insurance</div><div>
Health Savings &amp; Flexible Spending Accounts (up to $5,000 for childcare)</div><div>
Tuition discounts &amp; reimbursement</div><div>
401(k)</div><div>
Company Paid Time Off*</div><div>
Shift Differential</div><div>
DailyPay</div><div>
Pet Insurance</div><div>
Employee wellness and discount programs</div><div>
</div><ul><li>Benefits may vary by employment status</li></ul>
Responsibilities:
<ul><li>Verifies patient prescription benefits, including medical and pharmacy coverage, to ensure accurate billing and reimbursement</li><li>
Investigates authorization requirements for medications and any ancillary supplies, collaborating with healthcare providers and insurance companies as necessary</li><li>
Determines patient eligibility for copay card assistance programs based on program criteria and facilitate enrollment as appropriate</li><li>
Knowledgeable to perform all Benefit Investigation functions. Provides thorough, accurate and timely responses to requests</li></ul>
Qualifications:
<ul><li>High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy</li><li>
1+ years pharmacy experience</li><li>
Pharmacy or healthcare-related knowledge</li><li>
Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication</li><li>
Basic math and analytical skills</li><li>
Intermediate typing/keyboard skills</li></ul>
About our Line of Business: Amerita, an affiliate of BrightSpring Health Services, is a specialty infusion company focused on providing complex pharmaceutical products and clinical services to patients outside of the hospital. Committed to excellent service, our vision is to combine the administrative efficiencies of a large organization with the flexibility, responsiveness, and entrepreneurial spirit of a local provider. For more information, please visit www.ameritaiv.com. Follow us on Facebook, LinkedIn, and X. Additional Job Information:
<ul><li>Percentage of Travel: 0-25%</li></ul>
Salary Range: USD $21.00 - $26.00 / Year</div>

Benefits Investigation Specialist/ Remote

Molina Healthcare

<div>JOB DESCRIPTION Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
<div> 
<ul><li>Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.</li><li>Analyzes clinical service requests from members or providers against evidence based clinical guidelines.</li><li>Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.</li><li>Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.</li><li>Processes requests within required timelines.</li><li>Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner.</li><li>Requests additional information from members or providers as needed.</li><li>Makes appropriate referrals to other clinical programs.</li><li>Collaborates with multidisciplinary teams to promote the Molina care model.</li><li>Adheres to utilization management (UM) policies and procedures.</li></ul> 
</div>Required Qualifications
<ul><li>At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.</li><li>Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.</li><li>Ability to prioritize and manage multiple deadlines.</li><li>Excellent organizational, problem-solving and critical-thinking skills.</li><li>Strong written and verbal communication skills.</li><li>Microsoft Office suite/applicable software program(s) proficiency.</li></ul> 

Preferred Qualifications<div> 
<ul><li>Certified Professional in Healthcare Management (CPHM).</li><li>Recent hospital experience in a medical unit or emergency room.</li></ul> 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</div></div>

Care Review Clinician

Edge

<div>
 
 
 Who We Are
 
 
 
 EDGE is building a bridge between Top Global Talent and the US Healthcare &amp; Insurance Industry. We are on a mission to create a borderless network of exceptional talent with people at the center of everything we do. See our values and more on onedge.co.
 
 
 
 
 
 
 Role Overview
 
 
 
 We are looking for virtual healthcare professional for US-based healthcare providers.
 
 The ideal candidate will possess a healthcare-related degree and a solid foundation in the US healthcare ecosystem.
 
 
 
 Operating as a key member for US based clinics and healthcare practices, this professional will act as a critical liaison between patients, healthcare providers, and insurance companies. The position requires a meticulous, tech-savvy individual capable of navigating complex insurance portals and electronic health records, while ensuring patients receive timely access to the care they need.
 
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 1. Insurance Verification &amp; Eligibility
 
 
 <ul>
 <li>
 Conduct comprehensive
 
 eligibility checking
 
 and
 
 benefits verification
 
 for patients prior to their scheduled appointments.
 </li>
 <li>
 Accurately interpret complex insurance policies, differentiating between
 
 PPO, HMO, and Medicare/Medicaid
 
 guidelines.
 </li>
 <li>
 Determine patient financial responsibilities, including
 
 deductibles, copays, and coinsurance
 
 , and clearly document these findings within the practice management system.
 </li>
 </ul>
 
 
 2. Prior Authorization Management
 
 
 <ul>
 <li>
 Prepare, compile, and
 
 submit prior authorization requests
 
 to insurance companies via web portals, fax, or phone.
 </li>
 <li>
 Review clinical documentation (progress notes, lab results, physician orders) to ensure medical necessity criteria are met before submission.
 </li>
 <li>
 Proactively track the status of pending authorizations, manage appeals for denied claims, and expedite urgent requests to prevent delays in patient care.
 </li>
 </ul>
 
 
 3. Data Integrity &amp; Compliance
 
 
 <ul>
 <li>
 Review and interpret
 
 Explanation of Benefits (EOB)
 
 to identify and resolve authorization-related billing discrepancies.
 </li>
 <li>
 Maintain strict confidentiality and ensure full compliance with
 
 HIPAA regulations
 
 and US healthcare data privacy laws.
 </li>
 <li>
 Accurately update Electronic Health Records (EHR) and Practice Management Systems with approved authorization numbers, effective dates, and covered service codes.
 </li>
 </ul>
 
 
 
 
 
 Requirements
 
 
 <ul>
 <li>
 
 Education:
 
 A healthcare-related degree (e.g., Nursing, Pharmacy, Healthcare Administration, Public Health) is highly preferred.
 </li>
 <li>
 
 Experience:
 
 Must have
 
 1&ndash;2 years of direct experience
 
 in the US Healthcare industry, with a proven track record in prior authorizations and insurance verification.
 </li>
 <li>
 
 Core Knowledge:
 
 Deep understanding of US insurance concepts, including
 
 PPO, HMO, EOBs, copays, and patient benefits
 
 .
 </li>
 <li>
 
 Technical Skills:
 
 Proficiency in navigating insurance portals (e.g., Availity, Optum, Covermymeds) and electronic health record/practice management systems (e.g., ECW, Tebra, Dentrix etc).
 </li>
 <li>
 
 Competencies:
 
 Exceptional attention to detail, strong analytical skills,
 
 excellent written and verbal English communication
 
 , and the ability to work independently in a fast-paced environment.
 </li>
 </ul>
 
 
 
 
 
 What We Offer
 
 
 
 At Edge, we believe our greatest innovation is our people. When you join our globally minded team, you&rsquo;ll thrive in a supportive, forward-thinking environment where your growth and well-being are our top priorities.
 
 
 We protect your peace of mind by offering a competitive starting base salary of
 
 USD 750
 
 , comprehensive health and life insurance, and a balanced leave package designed to support you and your family. This includes 14 annual vacation days with leave encashment options, 12 calendar weeks of paid maternity leave, 2 calendar weeks of paid paternity leave, and all mandated public holidays by Pakistani Law.
 
 
 Discover a career where you can truly push boundaries, fully backed by a team that invests in your future and respects your rights.
 
 
 
 
 
 
 Our Hiring Process
 
 
 <ol>
 <li>
 
 Application Review:
 
 Submit your application and resume. Our team carefully evaluates all candidates to ensure a good fit.
 </li>
 <li>
 
 Edge Interview:
 
 You'll be invited to connect with a representative from Edge to present a detailed and tailored fit to your profile.
 </li>
 <li>
 
 Client Interviews:
 
 Successful candidates finish an onboarding &amp; training phase and are placed in client interviews to showcase their skills and align with specific client needs.
 </li>
 <li>
 
 Final Selection:
 
 Once a good match is made, you&rsquo;ll join the Edge Global Talent Community, ready to make an impact in the world of healthcare.
 </li>
 </ol>
 
 
 
 
 
 Why Choose Edge?
 
 
 <ul>
 <li>
 Be part of a dynamic, global community that values your skills.
 </li>
 <li>
 Work on projects that make a real difference in people's lives.
 </li>
 <li>
 Enjoy a clear path for career growth and development.
 </li>
 <li>
 Be a part of a people-first and talent-centric culture.
 </li>
 </ul>
 
 
 
 
 
 Talent Boilerplate
 
 
 
 At Edge, we&rsquo;re on a mission to create a world where geographic borders are no longer a barrier for people to obtain full-time employment and fair wages. That&rsquo;s why we&rsquo;ve created a global hiring network that seamlessly connects exceptional talent from all over the world with businesses in North America that most need to fill positions. The Edge Talent Network is a community of like-minded professionals through which you can unlock your potential, showcase your skills, and earn what you&rsquo;re worth.
 
 
 
 
 
 
 Equal Opportunity Employer Statement
 
 
 
 Edge is proud to be an equal-opportunity employer. We are committed to fostering a diverse and inclusive work environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, physical or mental disability, age, veteran status, or any other legally protected basis.
 
</div>

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4773 prior authorization specialist jobs Near Me

Prior Authorization Specialist

Prior Authorization Specialist

Reimbursement Specialist Supervisor - Remote

Cardiac CT Reporting Operations Specialist

Benefits Investigation Specialist/ Remote

Care Review Clinician

Healthcare Virtual Assistant