Insurance Specialist - Prior Authorization (Remote) - Eastern Time zone

Med A/Rx•Rocky River, OH

3d•$18 - $21•Remote

About The Position

The Insurance Specialist - Prior Authorization is responsible for obtaining prior authorizations, verifying insurance benefits, and ensuring compliance with payer requirements before services are delivered. This role works closely with patients, providers, clinical teams, and insurance carriers to secure approvals, resolve authorization issues, and support accurate reimbursement. Success in this role requires strong knowledge of insurance verification, payer guidelines, eligibility requirements, authorization processes, and healthcare revenue cycle operations.

Requirements

High School Diploma or GED
2+ years of prior authorization, insurance verification, medical billing, patient access, or healthcare revenue cycle experience
Experience with Medicare, Medicaid, and commercial payers
Experience with Workers' Compensation pre-access or authorization processes
Knowledge of insurance eligibility, authorization, and benefits verification processes
Proficiency with Microsoft Office (Outlook, Word, and Excel)

Nice To Haves

Experience working in a hospital, physician practice, or healthcare revenue cycle environment
Experience using Epic, Cerner, Meditech, or other healthcare information systems
Experience utilizing payer portals and authorization systems
Knowledge of medical terminology and coding
Previous remote healthcare experience

Responsibilities

Verify patient insurance eligibility, benefits, and coverage requirements.
Obtain prior authorizations and referrals from insurance carriers in accordance with payer requirements.
Communicate with insurance companies, provider offices, and patients to collect information necessary for authorization approval.
Research and resolve authorization-related issues that could impact patient access to services.
Review accounts for medical necessity, payer requirements, and benefit limitations.
Document authorization activity and maintain accurate account records.
Update patient demographic, insurance, and payer information as needed.
Monitor authorization status and ensure timely follow-up on pending requests.
Utilize payer portals, eligibility tools, and healthcare software systems to support authorization activities.
Maintain established productivity, quality, and accuracy standards.
Collaborate with operational, billing, and clinical teams to support reimbursement and patient access goals.