Prior Authorization Specialist (Orthopedic) ID-5035

December 27, 2024

Description

MedCore Solutions, the healthcare division of Bizforce, is seeking a skilled Prior Authorization Specialist to join our growing team. The Prior Authorization Specialist is primarily responsible for obtaining all prior authorizations. These prior authorizations include biologic medications, procedures, prescriptions, and outpatient 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.

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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 care

Requirements

Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
Strong understanding of medical billing and insurance processes
Excellent communication and interpersonal skills
Detail-oriented with strong organizational skills
Ability to work independently and meet deadlines
Comfortable working in a remote, work-from-home setup
Average English communication skills
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 connectionfor 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)

Benefits

Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.

Permanent Work From home
Permanent Weekends Off
Great Company Culture and No Micromanagement
Annual Bonus

Who We Are

MedCore Solutions (MCS) is a single-source solution for Healthcare administration. MCS is an industry leader in medical billing, credentialing, scribing, insurance verification, compliance, and virtual staffing.

We offer an expansive suite of administrative products and training to keep your practice and its employees safe and up-to-date with compliance and to avoid fines and litigation. Our online compliance center is quick and easy to use and provides you with an extensive library of training courses, covering OSHA, HIPAA, Human Resources, Health Plan Management, Patient Safety and Regulations, Infection Control, and much more.