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Prior Authorization Specialist (US Healthcare) | Permanent WFH at BizForce. #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 patient 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 . Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare. . Strong knowledge of insurance verification processes and payer/billing guidelines.. . Excellent communication and interpersonal skills to work effectively with patients, providers, and insurers.. . Detail-oriented with strong organizational skills. . Ability to work independently and meet deadlines. . Comfortable working in a remote, work-from-home setup. . Amenable to work in a graveyard shift. . System Requirements. . Device (Desktop or Laptop). . . . Processor. :. . . . Windows Devices. : Intel Core i5 (or higher) or AMD Ryzen 5 (or higher).. . . Mac Devices. : Apple M1 chip or newer.. . . . RAM. :. . Minimum of 8GB or higher for optimal performance.. . . Operating System. :. . . . Windows. : Windows 11 Pro (Windows 10 Pro is acceptable but not preferred). The operating system must have a legitimate license.. . . Mac. : macOS compatible with M1 or newer chips.. . . . Hard Disk. :. . At least an SSD for faster processing and performance.. . . Internet Connectivity. :. . . Minimum speed of 50 Mbps via a . wired connection. for stability and reliability.. . A backup internet connection is highly recommended.. . . . *Power Supply. :. . A backup power supply (e.g., UPS or generator) to prevent disruptions during power outages . (optional but encouraged). . . Company Location: Philippines.