Prior Authorization & Billing Specialist

Job Title: Prior Authorization & Billing Specialist

Position type: Full-Time

Working Hours: 9:00 AM – 6:00 PM Pacific Daylight Time , Monday - Friday
Salary rate: $5-$6

Key Responsibilities:

• Handle, process, track, and follow up on prior authorization requests to ensure timely approvals and continuity of patient care.
• Answer and triage incoming patient calls, gather relevant patient information, address general inquiries, and route concerns to the appropriate healthcare personnel.
• Process prescription refill requests, coordinate with healthcare providers for approval, and monitor pending requests to ensure timely follow-up.
• Manage end-to-end medical billing processes, including claims preparation, submission, routing, payment posting, claim status monitoring, and follow-ups on outstanding or denied claims.
• Verify patient insurance eligibility, benefits, and coverage manually when insurance information or package selections in Athena EHR require correction.
• Assist with overflow patient calls during high-volume periods while maintaining professional and empathetic communication.
• Maintain accurate patient records, insurance information, authorization statuses, and billing documentation in the practice's EHR system.
• Coordinate with healthcare providers, insurance representatives, pharmacies, and internal team members to resolve patient and administrative concerns.
• Ensure accuracy, confidentiality, and compliance with HIPAA regulations when handling patient information.

Requirements

• At least 1 year of experience in medical virtual assistance, healthcare administration, medical billing, prior authorization, or a similar healthcare-related role.
• Strong understanding of medical administrative workflows, with willingness to undergo training for practice-specific processes.
• Experience handling patient calls, triage, intake, and patient coordination.
• Knowledge of prescription refill workflows, insurance eligibility verification, and medical claims processes.
• Excellent English communication skills, both written and verbal.
• Strong organizational skills, attention to detail, and ability to manage multiple responsibilities efficiently.
• Ability to work independently in a remote healthcare environment while maintaining patient confidentiality.

Basic Requirements

• Must speak and write English clearly and professionally.
• Must have relevant work experience.
• Must be able to provide an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
• Must be available to attend video meetings with camera on when required.

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.

Originally posted on Himalayas