Authorizations Specialist | US Healthcare | EST Hours | Remote

ISTA Personnel Solutions is a fast-growing, global BPO company. We are not a recruitment agency. We operate as a dedicated extension of our U.S.-based clients’ teams, delivering high-quality operational support with precision, efficiency, and professionalism.

We are recruiting on behalf of a growing U.S.-based healthcare and wellness company for an Authorizations Specialist to join their team and support insurance authorizations, payer requirements, patient benefits, and related healthcare administrative processes.

As an Authorizations Specialist, you will manage insurance authorization requests from submission through approval, denial, or reauthorization. You will work closely with healthcare providers, insurance carriers, billing and pharmacy teams, and internal departments to ensure authorization and payer requirements are completed accurately and within required timeframes.

This role is well suited to someone with experience in healthcare insurance authorizations, medical aid, benefits verification, medical billing, claims, referrals, or related healthcare administration, who is highly organised, detail-oriented, proactive, and comfortable managing multiple cases and follow-ups in a fast-paced environment.

PLEASE NOTE:

• Working Hours: Monday – Friday | 09:00 AM – 18:00 PM EST (15:00 PM – 00:00 AM South African time – subject to daylight savings). Flexibility may be required on Fridays, with later hours potentially being spread across the week when required.
• Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA).
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered.
• Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered.
• Work Environment: Fully remote

Key Responsibilities:

• Managing insurance authorization requests from submission through approval, denial, or reauthorization.
• Reviewing patient information and clinical documentation to ensure payer and authorization requirements are met.
• Monitoring authorization statuses, expiration dates, and upcoming appointments to identify potential gaps or delays.
• Coordinating Single Case Agreements (SCAs) and providing status updates to relevant teams.
• Completing required online enrolments relating to compliance programs, patient benefits, and payer or treatment requirements.
• Managing payer-specific requirements, including TRICARE referrals and authorizations.
• Processing and monitoring pharmacy prior authorizations and medication-related approvals.
• Maintaining accurate authorization, payer, enrolment, and patient information within Salesforce and other relevant systems.
• Preparing and managing required evaluation and billing-related documentation.
• Communicating with insurance carriers, billing partners, healthcare providers, pharmacy partners, and internal teams regarding authorization, enrolment, and benefits requirements.
• Proactively following up on outstanding requests, missing documentation, denials, enrolments, and other barriers to treatment.
• Completing required reports and assisting with monitoring authorization and patient scheduling activity.
• Assisting with the development and documentation of authorization, enrolment, and payer-specific workflows.
• Supporting system and workflow improvement initiatives to increase efficiency and reduce delays in patient care.

Requirements

• Previous experience in healthcare insurance authorizations, medical aid authorizations, benefits verification, medical billing, claims, utilization management, or related healthcare administration is preferred.
• Experience working with medical aids, insurance providers, payer portals, or online healthcare enrollment systems is advantageous.
• A good understanding of insurance benefits, prior authorizations, referrals, claims, and payer requirements is preferred.
• Strong organisational and time-management skills, with excellent attention to detail and accuracy.
• Strong written and verbal communication skills.
• Ability to manage multiple cases, priorities, deadlines, and follow-ups simultaneously.
• Strong problem-solving and critical-thinking skills.
• Proactive and self-motivated, with the ability to independently follow up on outstanding tasks and see them through to completion.
• Comfortable working with technology and learning new systems - Salesforce experience is a plus.
• Able to work collaboratively with clinical, administrative, billing, pharmacy, and other internal teams.
• Ability to maintain confidentiality and appropriately handle sensitive patient information.
• Adaptable and comfortable working in an environment where processes and workflows may continue to develop and improve.
• Previous experience supporting a U.S. healthcare client or working with U.S. insurance/payer requirements is advantageous.

If you are not contacted within 14 working days, please consider your application unsuccessful.

Originally posted on Himalayas