Overview:

Our client is looking for a Medical Insurance Verification & Prior Authorization Specialist to handle insurance verification, prior authorizations, and claims coordination with accuracy and care. You will work closely with patients, providers, and payers to ensure services are approved before procedures and documentation is complete and compliant. If you have experience with US health insurance authorization, strong data entry skills, and can multitask in a fast-paced environment, this is a great opportunity to grow in a stable healthcare support role. Join a team that values professionalism, quality, and compassionate communication.

Schedule: Monday - Friday, 8:30 AM - 5:30 PM Eastern Time | With a 30-minute unpaid break (40 work hours per week)

Responsibilities:

• Complete accurate and timely insurance verification
• Complete accurate and timely third-party prior payer authorization requests, including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes) are available
• Ensure services scheduled by outside providers have approved authorization as required by payer and procedure prior to service
• Communicate with patients, insurers, and other appropriate parties pertaining to insurance verification and authorization
• Provide clear documents for clearance/authorization to proceed with office visits and/or procedures
• Create a positive patient experience by being polite, compassionate, and professional
• Provide cross-coverage and training when needed for other team members
• Maintain productivity and quality performance expectations
• Review and meet ongoing competency requirements of the role to maintain the skills, knowledge, and abilities to perform within scope role-specific functions

Requirements:

• Previous experience obtaining prior authorizations for orthopedic procedures and services (must-have)
• Previous experience in insurance verification preferred
• Experience in claims verification and submission
• Experience with Accounts Receivable (AR), Explanation of Benefits (EOB), and claims processing/follow-up is highly preferred
• Experience using Athenahealth (Athena) is highly beneficial
• Experience with U.S. health insurance authorization processes
• Strong understanding of insurance eligibility verification, prior authorizations, and payer requirements
• Regular attendance is required to carry out the essential functions of the position

Independent Contractor Perks:

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations

Note:

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

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