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Prior Authorization Specialist at Winning Assistants. Job Title: Prior Authorization Specialist . Job Code: . [JW-BODB]. Position Type: . Full-time. Work Hours: . 8:00 AM - 5:00 PM Eastern Standard Time, Monday - Friday. Salary rate: . $5-$7per hour. Key Responsibilities. Gather clinical documentation, confirm medical necessity criteria, submit requests via payer portals (e.g., Availity), CoverMyMeds, fax, or phone.. Monitor status queues daily, follow up within payer timelines, and manage renewals/reauthorizations proactively.. Verify eligibility and benefits through online portals, clearinghouses, and outbound payer calls.. Confirm and document: copays, deductibles, coinsurance, OOP max, plan type, effective dates, coverage limitations, and authorization/referral requirements.. Flag and resolve discrepancies (inactive coverage, wrong member ID, plan mismatches) before service dates to prevent denials.. Review EOB/ERA/denial messages, identify root cause (eligibility, auth, coding, medical necessity, timely filing, documentation, referral).. Coordinate corrections, resubmissions, peer-to-peer requests, and formal appeals as needed.. Experience Requirements:. Healthcare-related education or experience (nursing, pharmacy, medical admin, billing, etc.). 1–2+ years experience in prior authorizations, medical billing, pharmacy coordination, or insurance verification. Comfortable with insurance portals and payer processes (e.g., Availity, CoverMyMeds) and EHR systems. Knowledge of eligibility/benefits and denials/appeals workflows. Strong communication, organization, and attention to detail. Able to work independently in a fast-paced setting. Follows HIPAA, payer rules, and protects patient confidentiality. Basic requirements. Must be proficient in speaking and writing English very clearly. Must have relevant work experience. Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory]. Must be available for video meetings with your camera on (when needed). Technical requirements. Device: . Reliable laptop or desktop computer.. Internet:. High-speed connection (minimum 10 Mbps).. Audio: . Noise-canceling headset.. Video:. Webcam for virtual meetings.. Workspace: . Quiet, professional environment.. Company Location: Philippines.