Prior Authorization Specialist remote jobs - 686 jobs

One of our top clients is looking for a team of Patient Access Representatives within a call center environment in Beverly Hills, CA! This person will be responsible for handling about 50+ calls per day for multiple specialty offices across Southern California. This position is fully on-site for 2 - 4 months, then fully remote. Required Skills & Experience HS Diploma 2+ years healthcare call center experience (with an average call time of 5 minutes or less on calls) Proficient with scheduling appointments through an EHR software 2+ years experience scheduling patient appointments for multiple physicians in one practice 40+ WPM typing speed Experience handling multiple phone lines Nice to Have Skills & Experience Proficient in EPIC Experience verifying insurances Basic experience with Excel and standard workbooks Experience in either pain management, dermatology, Neurology, Endocrinology, Rheumatology, or Nephrology. Responsibilities Include: Answering phones, triaging patients, providing directions/parking instructions, contacting clinic facility to notify if a patient is running late, scheduling and rescheduling patients' appointments, verifying insurances, and assisting with referrals/follow up care. This position is on-site until fully trained and passing multiple assessments (typically around 2-4 months of working on-site - depending on performance) where it will then go remote.

TEKsystems has a current opening for a remote insurance follow up/medical billing candidate. Qualified individuals will have a minimum of 2 years of experience with Iowa and/or Illinois Medicaid and Medicare insurance follow up experience. *Description* Daily Duties: * Work with centralized cash posting team to resolve missing or unposted remite * Ensure all claims are accurately transmitted daily and all appropriate documentation is sent when required * Verify eligibility and claims status on unpaid claims * Provide timely feedback to management of identified claims issues, repetitive errors, and payer trends to expedite claims adjudication * Work accounts in assigned queues in accordance with departmental guidelines * Work directly with third party payers and internal/external customers toward effective claims resolution. *Skills & Qualifications* High School graduate or equivalent Must have Iowa and/or Illinois Medicaid payer experience Physician Billing and Denial/Follow Up experience - 2+ years EPIC experience Payer portal claim corrections and reconsiderations knowledge - ex. Availity Work from home space required *Job Type & Location*This is a Contract position based out of West Des Moines, IA. *Pay and Benefits*The pay range for this position is $19.00 - $22.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) *Workplace Type*This is a fully remote position. *Application Deadline*This position is anticipated to close on Jan 23, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

**Join our dynamic team as a frontline patient care representative who interacts with our patients to provide exceptional and compassionate patient care! The patient care representative may have the option to work remotely after an introductory training period. General Job Summary: Vital to the success of our organization with providing OrthoCincy patients and all other callers a premier Ortho experience while focusing on their individual needs. Essential Job Functions: Schedules appointments for patients either by phone when they call in, through the company website or when requested from the clinic via computerized message system. Uses computerized system to match physician/clinician availability with patients' preferences in terms of date and time. Ability to handle a high volume of incoming calls, while maintaining a high standard of productivity, efficiency and accuracy while working under pressure. Must be able to respond to various inquiries made by patients, hospitals, insurance companies, as well as other medical entities. Engaging in active listening with all callers, while acting as a contact point person between patients, providers and staff. Maintains scheduling system so records are accurate and complete and can be used to analyze patient/staffing patterns. Updates physicians/clinicians or medical assistants. Ensures that updates (e.g. cancellations or additions) are input daily into master schedule. Send requests to clinic for prescription refills and follow up with patients on messages from clinic via computerized message system. Establish and maintain effective working relationships with patients, providers, co-workers, and the public. Maintaining a calm, pleasant and compassionate tone while being able to diffuse tense situations. Follows HIPAA regulations. Perform other duties necessary or in the best interest of the department/organization. Requirements Education/Experience: High school diploma. Minimum one year experience in a medical practice and/or position encouraged. Experience in a high volume call center a plus. Other Requirements: Schedules will change as department needs change. Performance Requirements: Knowledge: Knowledge of OrthoCincy's Mission, Vision and Values. Knowledge of medical practice protocols related to scheduling appointments. Knowledge of anatomy and medical terminology. Knowledge of computerized scheduling systems. Knowledge of customer service principles and techniques. Knowledge of OSHA and safety standards. Skills: Skill in communicating effectively with providers, employees, customers and patients. Skill in maintaining appointment schedule via computerized means. Effective in critical thinking skills. Strong communication skills in a professional manner during stressful and sensitive situations with patients of all ages. Abilities: Ability to multi-task effectively Ability to communicate calmly and clearly Ability to analyze situations and respond appropriately. Ability to alternate between multiple computer systems in a timely manner. Equipment Operated: Standard office equipment. Work Environment: Standard call center workstation. Mental/Physical Requirements: Involves sitting and viewing a computer monitor 90% of the work day. Must be able to remain focused and attentive without distractions (i.e. personal devices).

Remote Sales Insurance Specialist Are you enthusiastic, self-motivated, and eager to learn? Do you thrive in a fast-paced environment and aren't afraid of hard work? If so, we want to hear from you! At Globe Life: The Gelb Group, we are dedicated to protecting the hardworking middle class. As a Virtual Sales Insurance Specialist, you'll embark on a structured 3-6 month training program designed to provide you with in-depth industry knowledge and hands-on experience. You'll gain valuable insights into our history, mission, and vision while developing the skills necessary to excel and grow within our company. What Youll Do: Master the daily operations of the business through hands-on training. Work directly with customers to tailor permanent benefits that meet their family's needs. Build and maintain strong relationships with organizations such as the Police Association, Nurses Association, Firefighters, Postal Workers, Labor Unions, and more. Develop essential skills in communication, leadership, organization, time management, networking, and team building. Learn business logistics and strategies to maximize earnings and profitability. What Were Looking For: Leadership experience is a plus, but not required. A strong willingness to learn and be coachable. Ability to accept and apply constructive feedback. Strong people skills and a great sense of humor! Highly organized and team-oriented. Company Perks & Benefits: Incentive Trips to destinations like Cabo, Tulum, Vegas, and Cancun. 100% Remote Work from anywhere! Weekly training calls to support professional growth. Performance-based weekly pay & bonuses. Health insurance reimbursement. Life insurance & retirement plan. If youre ready to take your career to the next level, apply today with your most up-to-date resume! Its not about where you startits about where you finish! Overview: American Income Life has been a leading provider of life and supplemental benefits for working families since 1951. We have established strong relationships with unions and associations across the United States. As the company grows rapidly, we are now offering remote positions to serve families across all time zones nationwide. This is an entry-level position with a potential annual income ranging from $60,000 to $80,000. Responsibilities: Assist clients by providing information about products and services Address client questions regarding their coverage Continuously develop and maintain an understanding of evolving products and services Regularly review client agreements to identify opportunities for cost-effective improvements Qualifications: Previous experience in customer service, sales, or a related field (not required) Ability to build rapport with clients Strong multitasking and organizational skills Positive, professional demeanor Excellent written and verbal communication skills What We're Looking For: A sharp individual with an entrepreneurial mindset A team player who thrives under pressure Someone with professional communication skills Benefits: Comprehensive hands-on training Weekly pay Performance-based bonuses Commission-based income Residual income opportunities Company-paid trips Remote work flexibility Compensation details: 55000-100000 Yearly Salary PI7bb73ca605f2-31181-38920149

The Pre-registration Specialist is responsible for ensuring accurate and timely pre-registration of patients for scheduled services. This role includes generating estimates, communicating with patients regarding their financial obligations, securing pre-service payments or establishing payment arrangements, and ensuring all demographic and insurance information is accurate. The Pre-registration Representative/Specialist plays a critical part in optimizing financial outcomes and enhancing patient experience through effective communication and financial counseling. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Pre-registration & Verification - Complete pre-registration for scheduled services, ensuring all required information is obtained and accurately entered into the system. - Verify patient insurance coverage and eligibility prior to scheduled services. - Ensure all demographic and insurance information is accurate and up to date. Financial Analytics & Patient Interaction - Generate accurate cost estimates for scheduled services based on payer contracts and patient insurance coverage. - Communicate with patients regarding their financial obligations, including co-pays, deductibles, and out-of-pocket costs. - Secure pre-service payments or establish payment arrangements prior to the date of service. - Provide clear and empathetic financial counseling to patients, ensuring understanding and satisfaction. - Interact with patients to address any questions or concerns related to their financial responsibilities. Documentation & Compliance - Maintain accurate and up-to-date records of all pre-registration activities in the electronic health record (Epic) and patient accounting systems. - Ensure compliance with HIPAA, payer guidelines, and internal policies. - Participate in audits and quality improvement initiatives as needed. QUALIFICATIONS: Education & Experience - High school diploma or equivalent required, associate or bachelor's degree in healthcare administration, finance, or related field preferred. - Minimum 2 years of experience in patient access, pre-registration, or revenue cycle operations, preferably in a healthcare setting. Skills & Competencies - Strong understanding of healthcare finance, insurance verification, and pre-registration processes. - Proficiency in generating cost estimates and communicating financial obligations. - Excellent analytical, problem-solving, and communication skills. - Ability to work independently and collaboratively in a fast-paced environment. - Experience with EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite. Pay Range: $19.03-$31.39 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Remote-Rhode Island - N/A Providence, Rhode Island 02901 Work Type: Mon-Fri Work Shift: Day Daily Hours: 8 hours Driving Required: No

Quadris Team, LLC - A Revenue Cycle Management Group, is searching for that dynamic person to join us, working with our highly skilled Authorizations Team to fill the role of Prior Authorization Specialist for General Surgery. We are a 100% remote team supporting our clients across the United States! See us at ******************** The ideal applicant will reside in Pacific Standard Time or Mountain Standard Time Job Focus: Responsible for obtaining prior authorizations for facility services based on assigned specialty or clinic area. This position will secure the prior authorization and notify the rendering party in the timeliest manner possible so patients can receive necessary care and services with the least delay. Responsible for answering patient calls, providing outgoing patient communication regarding financial obligations and authorization status. Responsible for patient estimation, benefit education, and payment processing. Primary/Essential Expectations For Success: Accurately, efficiently and timely work prior authorization requests-referrals Receive request for prior authorizations through the electronic health record (EHR) and/or via phone, email or fax and ensure that they are properly and closely tracked and monitored Process referrals and submit medical records to insurance carriers to expedite prior authorization processes Manage correspondence with insurance companies, physicians, specialists and patients as needed, including documenting in the EHR as appropriate Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed Review accuracy and completeness of information requested and ensure that all supporting documents are present Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial Prioritize the incoming authorizations by level of urgency and date of service Secure patient information in accordance with client policy/procedures Other duties as assigned Monitors WQs, and resolves accounts in a timely manner Stay up to date on insurance company policies and procedures related to prior authorizations Physical/Mental Demands, Environment: Prolonged periods of sitting at a desk and working on a computer Must be able to lift 15 pounds at one time Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations Skills Needed to Be Successful: Maintains compliance with regulations and laws applicable to job Professional level of communication with video, phone, and email Ability to effectively prioritize the work to meet deadlines and expectations Meets the quality and productivity measures as outlined by Quadris Brings positive energy to work Uses critical thinking skills Being present and focused on assigned tasks and eliminates distractions Being a self-starter Ability to work independently and within a team atmosphere Core Talent Essentials: High School diploma or equivalent 1+ years of experience working in health care, medical billing, with a focus on prior authorization preferred PACS (Prior Authorization Certified Specialist) Certification preferred Knowledge of insurance process and medical terminology preferred Honors and sets high expectations for patient confidentiality and customer service in accordance with Quadris Team policies and procedures and HIPAA requirements Advanced level of industry standard electronic medical record content Must have professional level skills in MS products such as Excel, Word, Power Point. Proficient application of business/office standard processes and technical applications

About Orsini Rare Disease Pharmacy Solutions Providing compassionate care since 1987, Orsini is a leader in rare disease and gene therapy pharmacy solutions, built to simplify how patients connect to advanced medicines. Through our comprehensive commercialization solutions including a nationwide specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work with biopharma, providers, and payors to ensure No Patient is Left Behind™ Our Mission Orsini is on a mission to be the essential partner for biopharma innovators, healthcare providers, and payers to support patients and their families in accessing revolutionary treatments for rare diseases. Through our integrated portfolio of services, we seek to pioneer comprehensive solutions that simplify how patients connect to advanced therapies while providing holistic, compassionate care so that No Patient is Left Behind™. LIVE IT Values At the heart of our company culture, the Orsini LIVE IT core values serve as guiding principles that shape how we interact with each other and those we serve. These values are the driving force behind our commitment to excellence, collaboration, and genuine care in every aspect of our work. Leading Quality, Integrity, Valued Partner, Empathy, Innovation, Team-First Salary Range: $19-$23 Hourly Based on Experience Position Summary This position will work closely with the Benefits Verification Team to validate patient's insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical policies. Prior Authorization Representatives are responsible for contacting physician's offices to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans. Required Knowledge, Skills & Training Experience with Major Medical Insurance Knowledge of Pharmacy Benefit Knowledge of HCPC Codes (J-Codes) Knowledge of ICD-10 Codes (Diagnoses Codes) Familiar with medical documentation such as H&P's, Genetic testing, etc. Ability to read prescriptions Ability to convert a prescription into an authorization request based on payer requirements Ability to interpret medical policies Essential Job Duties Contact plans (PBM or Major Medical) to validate request sent from BV Contact physician's office to obtain current prescriptions Contact physician's office to obtain clinical documentation that is required by the plans Validate that the clinical documentation received is what is required by the plan Initiate prior authorizations through Cover My Meds Follow up on all pending PA's within 48 hours Respond to urgent emails submitted by the Patient Care Coordinator Team or Program Manager in a timely manner Obtain approval / denial letters Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process Initiate re-authorizations that are set to expire 30 days prior to the term date Employee Benefits BCBSL Medical Delta Dental EyeMed Vision 401k Accident & Critical Illness Life Insurance PTO, Holiday Pay, and Floating Holidays Tuition Reimbursement

Hi, we're Aidin! We're here to create solutions for healthcare's biggest challenges. Instead of waiting for someone else to step up, we rolled up our sleeves and created a better way to connect patients, payers, and care providers. We are on a mission to defragment the healthcare ecosystem with a seamless digital platform that transforms healthcare for good and improves outcomes for all. What we do Aidin is a dynamic healthcare technology company dedicated to revolutionizing care coordination and post-acute care transitions. Our innovative platform empowers healthcare organizations to streamline workflows, reduce costs, and ensure patients receive the highest quality post-acute care. You can learn more about us at **************** About The Opportunity We are seeking a dynamic, strategic leader and subject matter expert in Prior Authorizations to drive operational excellence and innovation at Aidin. This role is responsible for owning and scaling Aidin's Prior Authorizations function-ensuring consistent, high-quality execution while continuously improving processes, systems, and outcomes for clients, staff, and patients. As Prior Authorizations Manager, you will lead day-to-day operations and serve as the escalation point for complex payer, hospital, and provider issues. This is a hands-on role, requiring both ownership of the process and execution of the day to day activities as we grow and enhance this functionality at Aidin. You will partner closely with Client Operations, Product, and other cross-functional teams to shape strategy, influence roadmap decisions, and build a best-in-class authorization capability that supports Aidin's growth and mission: ensuring patients transition, on-time, to the best provider every time. This role reports to the Senior Director, Client Operations. Key Responsibilities Operational Ownership Oversee daily Prior Authorizations operations, ensuring queues are managed efficiently and authorizations are submitted accurately and on time Define and monitor key performance metrics; use data to identify trends, risks, and improvement opportunities Own payer onboarding and eligibility demarcation strategies across hospitals and markets Serve as the primary point of accountability for issue resolution with payers, including portal-based workflows such as Availity Provide real-time guidance and escalation support for complex authorization challenges Establish training, onboarding, and ongoing education programs to ensure team readiness as Aidin scales Process Improvement Design, document, and continuously refine standard operating procedures that scale with the business Identify opportunities to improve authorization workflows through automation, tooling, and process redesign Partner with Product to identify, quantify, and prioritize feature enhancements that meaningfully advance the Prior Authorizations business Contribute to broader Client Operations strategy, ensuring alignment with Aidin's growth objectives Cross-Functional Collaboration Work closely with Client Operations leadership, Product, and Customer-facing teams to ensure alignment and clarity Translate payer and operational complexity into actionable insights for internal stakeholders Represent the Prior Authorizations function as Aidin expands into new markets and payer relationships What You'll Bring 5+ years of direct experience in Prior Authorizations, including extensive payer portal and direct payer engagement across the U.S. Demonstrated experience leading or mentoring others, with a track record of driving operational results Deep understanding of payer workflows, eligibility requirements, and authorization best practices Strong problem-solving skills and comfort navigating ambiguity and complex edge cases A growth mindset, with ambition to build, scale, and improve systems and teams Excellent communication skills and the ability to influence across functions Adaptability and resilience in a fast-moving environment Startup, B2B SaaS, Healthcare IT, or health-tech experience strongly preferred What Success Looks Like A successful Prior Authorizations Manager: Brings confident leadership, operational rigor, and strategic thinking to the Prior Authorizations function Owns performance outcomes, including turnaround times, payer responsiveness, accuracy, and client satisfaction Builds scalable processes, documentation, and best practices that enable consistent execution across markets and payers Acts as a trusted internal expert and partner, translating operational realities into product and process improvements Culture and Values: At Aidin, our team is guided by four core values that shape everything we do: Lead, Do Not React: Think big-picture, long-term, and do the right thing. We want team members who take initiative and lead with vision, rather than simply reacting to circumstances Make a Difference: For us, outcomes are everything. Be the solution. We value making a tangible impact through every event and initiative Embrace Uniqueness: Boldly be who we are. Individuality and authenticity are strengths that we bring to our work Celebrate the Doer: We celebrate action and the people who make it happen. If you thrive on taking initiative and seeing real results, you'll fit right in Why Work at Aidin? Be a part of a trailblazing, mission driven organization that is revolutionizing patient care transitions Opportunity to work and grow with talented, mission-driven, passionate professionals Flexible remote work environment Generous PTO Policy, plus 12 national holidays Several Team Offsites each year where we come together and align on our vision, mission, values, and strategic initiatives Comprehensive benefits package Commitment to Diversity At Aidin, we strive to create a mindful and respectful environment where everyone can bring their authentic self to work, and experience a culture that is free of harassment, racism, and discrimination. That's why we are committed to diversity and inclusion in the workplace, and we prohibit discrimination and harassment of any kind based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other characteristic protected by law. This policy applies to all employment practices within our organization, including, but not limited to, hiring, recruiting, promotion, termination, layoff, and leave of absence.

The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. High School Diploma or GED and 2+ years of relevant experience required OR Bachelor's degree required Additional Requirements include: Prior Auth / Authorization, Cancer Services, Microsoft Office, Radiation Oncology, Insurance Verification, Appeals, and Pre Determination experience preferred. Ability to read and communicate effectively Basic computer/keyboarding skills, intermediate mathematic competency Good written and verbal communication skills Knowledge of proper phone etiquette and phone handling skills Position requires general knowledge of healthcare terminology and CPT-ICD10 codes. Basic knowledge of and experience in insurance verification and claim adjudication is preferred. Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view. Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. Knowledge of Denial codes is preferred. Knowledge of and experience using an Epic RC/EMR system is preferred. Healthcare Financial Management Association (HFMA) Certification Preferred. *This position is a 100% remote work. Individual may live anywhere in the US. **This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position. During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

The Precertification and Authorization Representative is an intermediate level position that is responsible for resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ED, and clinic/ambulatory environments. In addition, this position may be responsible for pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access department. This may include processing of pre-certification and prior authorization for workers compensation/third party liability (WC/TPL), managed care and HMO accounts, as well as working assigned registration denials for government and non-government accounts. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations. High School Diploma or GED and 2+ years of relevant experience required OR Bachelor's degree required Additional Requirements include: Prior Auth / Authorization, Cancer Services, Microsoft Office, Radiation Oncology, Insurance Verification, Appeals, and Pre Determination experience preferred. Ability to read and communicate effectively Basic computer/keyboarding skills, intermediate mathematic competency Good written and verbal communication skills Knowledge of proper phone etiquette and phone handling skills Position requires general knowledge of healthcare terminology and CPT-ICD10 codes. Basic knowledge of and experience in insurance verification and claim adjudication is preferred. Requires excellent verbal communication skills, and the ability to work in a complex environment with varying points of view. Must be comfortable with ambiguity, exhibit good decision making and judgment capabilities, attention to detail. Knowledge of Denial codes is preferred. Knowledge of and experience using an Epic RC/EMR system is preferred. Healthcare Financial Management Association (HFMA) Certification Preferred. *This position is a 100% remote work. Individual may live anywhere in the US. **This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position. During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps.

Job Description This role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process. Schedule: Monday - Friday 9:30am - 6:30pm CST We Offer: • Competitive Pay • Health, Dental, Vision & Life Insurance • Company-Paid Short & Long-Term Disability • Flexible Schedules & Paid Time Off • Tuition Reimbursement • Employee Discount Program & DailyPay • 401k • Pet Insurance Responsibilities Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply, ensuring compliance with payer requirements and clinical guidelines. Collaborate with healthcare providers, insurance companies, and patients to gather necessary clinical information and documentation to support prior authorization submissions. Submit prior authorization requests accurately and in a timely manner, utilizing electronic submission platforms and following established protocols. Knowledgeable to perform all PA functions. Qualifications High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy 1+ years pharmacy experience Pharmacy or healthcare-related knowledge Knowledge of pharmacy terminology including sig codes, and Roman numbers, brand/generic names of medication Basic math and analytical skills Intermediate typing/keyboard skills

Remote Prior Authorization Pharmacist - Work From Home in Managed Care A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe and effective therapies. This work-from-home position is ideal for pharmacists who want to transition out of retail or hospital settings while building expertise in managed care. Key Responsibilities Review prior authorization requests for accuracy, appropriateness, and clinical necessity. Apply plan criteria, evidence-based guidelines, and regulatory standards to determinations. Communicate approval/denial decisions clearly to providers and patients. Collaborate with physicians, nurses, and medical directors on complex cases. Document outcomes in compliance with health plan policies and CMS/state regulations. Support process improvements to streamline workflow and turnaround times. What You'll Bring Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree. Licensure: Active and unrestricted pharmacist license in the U.S. Experience: Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. Skills: Excellent clinical review, documentation, and communication skills. Why This Role? Flexibility: 100% remote work from home with flexible scheduling options. Impact: Directly influence patient access to safe and cost-effective medications. Growth: Build specialized skills in utilization management and managed care. Rewards: Competitive compensation, benefits, and career advancement opportunities. About Us We are a confidential healthcare partner working with health plans and PBMs across the U.S.. Our pharmacists ensure patients receive the right therapy at the right time while maintaining compliance with all regulations. Apply Today Take the next step in your career with our Remote Prior Authorization Pharmacist opportunity - and enjoy the benefits of working from home while shaping the future of managed care.

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Public Partnerships LLC (PPL) helps people with disabilities, chronic illnesses, or other long-term health conditions stay at home and “self-direct” their care. Known as consumer direction in New York, this long-term care model empowers people to take control of who provides their services and where. PPL was selected to be the Statewide Fiscal Intermediary for the New York Consumer Directed Personal Assistance Program (CDPAP) starting in 2025. We, along with a diverse alliance of service partners across the state, will be supporting the delivery of culturally sensitive and disability competent care to CDPAP participants. We are looking for people who share our passion for helping New Yorkers live happy, healthy, and independent lives to support CDPAP consumers and their personal assistants across a broad spectrum of services and functions. Our culture attracts and rewards people who are compassionate, results-oriented, and driven to exceed customer expectations. We desire motivated candidates who are excited to join our fast-paced, consumer-focused environment, and who want to make a difference in helping transform the lives of the people we serve. Learn more about PPL and CDPAP at *************************** Position Title: Registration Specialist Reports to: Registration Supervisor The Registration Specialist is responsible for supporting individuals and their authorized representatives in successfully enrolling and participating in self-directed service programs. This role ensures timely and accurate completion of enrollment processes, provides person-centered education, and collaborates with internal and external stakeholders to remove barriers and maintain compliance with program standards. Customer Service & Relationship Management Follows up on referrals for participant-directed services. Communicates with participant or authorized representative about additional supports or accommodations necessary for successful program participation. Provides person-centered, need-based program education and guidance to participants and authorized representatives specific to individual choices, goals, and desired outcomes. Educates the individual/employer on interacting with Public Partnerships as their fiscal intermediary, with emphasis on their authorized services, timesheet completion, enrolling subsequent providers and keys to successful self-direction. Communication & Education Explains and educates on participant/authorized representative and provider roles and responsibilities for participation in self-directed services, including processing payroll, vendor payments, tax withholding and reporting. Provides direct, including train-the-trainer, instruction on how to navigate program rules, expectations, and financial management systems, including online enrollment, service time capture, portal, and emerging technologies. Provides train-the-trainer instruction on identification and reporting of suspected fraud, abuse, neglect, and exploitation. Problem Solving & Critical Thinking Identifies potential barriers and bottlenecks to timely enrollment and takes necessary steps to triage and resolve. Engages the entity providing case management or service/support coordination services to the individual to ensure timely coordination of service approval and authorization. Collaborates with internal and external stakeholders as necessary to ensure enrollment cycle times are minimized and the first payment to the provider(s) is received on time and in full. Compliance & Risk Management Identifies, reports, and appropriately follows up on allegations or reports of suspected fraud. Assesses for participant abuse, neglect, and exploitation, following the appropriate reporting protocol where necessary. Meets quality assurance standards as applicable to program. Documents and reports evidence of individual's inability to self-direct appropriately. Technical & Administrative Skills Supports the individual/employer and their provider(s) in completing all necessary documentation required for enrollment. Performs all functions necessary to support the enrollment of the individual/employer/authorized representative and provider(s) including processing enrollment documentation, obtaining employer identification numbers, completing criminal background checks, and other enrollment related requirements. Updates enrollment status of individual participants and providers through portal and records in systems. Maintains documentation of services provided and time committed in accordance with applicable policies and procedures. Communicates referral corrections, as needed, to entities providing case management or service/support coordination entities services to the individual. Assessment & Evaluation Assesses participant's and/or authorized representative's ability to communicate, acquire new information, act as an employer and otherwise successfully participate in a self-directed employer and/or budget authority service model. Collaboration & Teamwork In collaboration with the enrollment supervisor, supports workforce management delegation to ensure service levels are met. Required Skills: Strong customer service and support experience Proficient in Microsoft Office Suite, CRM, Five 9, My Account platforms and web-based applications High aptitude for process assessment, improvement, and recommendations Exceptional verbal and written communication skills Ability to develop strong working relationships with external and internal stakeholders. Education: Related Bachelor's degree preferred; can be substituted with 1+ years of related experience. Experience: Additional education and experience requirements as indicated by state contract requirements. Minimum of one (1) year of experience serving individuals with disabilities and/ or aging adults preferred. Working Conditions: Hybrid (Latham, NY or Manhattan, NY) - combination of on-site and remote work Compensation: $20.00 - $22.00 hourly The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified. If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Who we are: Access TeleCare is the largest national provider of telemedicine technology and solutions to hospitals and health systems. The Access TeleCare technology platform, Telemed IQ, enables life-saving patient care through telemedicine and empowers healthcare organizations to build telemedicine programs in any clinical specialty. We provide healthcare teams with industry-leading solutions that drive improved clinical care, patient outcomes, and organizational health. We are proud to be the first provider of acute clinical telemedicine services to earn The Joint Commission's Gold Seal of Approval and has maintained that accreditation every year since inception. We love what we do and if you want to know more about our vision, mission and values go to accesstelecare.com to check us out. What you'll be responsible for: We are seeking an experienced and detail-oriented Patient Registration Specialist. The Patient Registration Specialist will support the team by accurately capturing patient demographic data and insurance coverage details to ensure correct insurance billing. This role requires a strong understanding of healthcare eligibility processes and insurance verification protocols throughout the assignment. What you'll work on: Perform comprehensive patient registration, including obtaining accurate demographic and insurance information from multiple Electronic Medical Record (EMR) systems and entering this info into Access TeleCare's billing system Verify insurance eligibility and coverage benefits using payer portals, phone calls, and real-time eligibility tools Identify and resolve issues related to insurance eligibility, including coordination of benefits and out-of-network policies Escalate complex coverage or registration issues to management or the billing department as needed Maintain compliance with HIPAA and all regulatory guidelines regarding patient data and insurance handling Other duties as assigned What you'll bring to Access TeleCare: High school diploma required A minimum of 1-2 years' experience in Revenue Cycle, Registration and Medical Billing Solid understanding of registration and billing Knowledge of medical terminology, anatomy, and physiology Must also have a focus on regulatory and billing requirements Ability to maintain confidentiality Strong communications skills (written and oral) as well as demonstrate the ability to work effectively across departments Demonstrated proficiency with Microsoft office programs (Excel, Word, and PowerPoint) communication, and collaboration tools in various operating systems Ability to work effectively under deadlines and self-manage multiple projects simultaneously Strong analytical, organizational, and time management skills Flexibility, detail-oriented, and adaptability in a fast-paced environment Ability to thrive in a high growth, fast-paced organization and 100% Remote based environment Must be able to remain in a stationary position 50% of the time About our recruitment process: We don't expect a perfect fit for every requirement we've outlined. If you can see yourself contributing to the team, we would like to speak with you. You can expect up to 2 interviews via Zoom. Access TeleCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, age, religion, color, marital status, national origin, gender, gender identity or expression, sexual orientation, disability, or veteran status.

Top Healthcare Provider Network The 61st Street Service Corporation, provides administrative and clinical support staff for ColumbiaDoctors . This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties. This position is primarily remote, candidates must reside in the Tri-State area (New York, New Jersey, or Connecticut). Note: There may be occasional requirements to visit the New York or New Jersey office for training, meetings, and other business needs. Opportunity to grow as part of a Revenue Cycle Career Ladder! Job Summary: The Authorization Specialist II is responsible for verifying insurance policy benefit information, and securing payer required authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient s visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to surgical procedures, outpatient treatments, medications and diagnostic testing (i.e. ultrasounds, labs, radiology, IV therapy, referrals) Job Responsibilities: Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone). Upon verification of patient's insurance coverage, update changes in the billing system. Confirms provider s participation status with patient s insurance plan/network. Determines payer referral and authorization requirements for professional services. Contacts patient and PCP to secure payer required referral for planned services. Documents referral in practice management system. Researches system notes to obtain missing or corrected insurance or demographic information. Reviews clinical documentation to insure criteria for procedure meets insurance requirements. Initiates authorization and submits clinical documentation as requested by insurance companies. Follows through on pre-certifications until final approval is obtained. Manage faxes, emails, and phone calls in a timely manner. Responds to voicemails and emails within same business day of receipt. Communicates with surgical coordinators regarding authorizations status or denials. Submits appeals in the event of denial of prior authorizations or denial of payment following procedures. Set up peer to peer calls with clinical providers and insurance companies, as needed. Calculate and document patient out of pocket estimates and provide to patient. Assists Supervisor with special projects and/or tasks. Assists Authorization-Referrals Specialist I with complex cases or questions. Serves as back-up to Authorization-Referrals Specialist III. Performs other job duties as assigned. Job Qualifications: Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone). Upon verification of patient's insurance coverage, update changes in the billing system. Confirms provider s participation status with patient s insurance plan/network. Determines payer authorization requirements for professional services. Researches system notes to obtain missing or corrected insurance or demographic information. Reviews clinical documentation to insure criteria for procedure meets insurance requirements. Initiates authorization and submits clinical documentation as requested by insurance companies. Follows through on pre-certifications until final approval is obtained. Manage faxes, emails, and phone calls. Responds to voicemails and emails. Communicates with surgical coordinators regarding authorizations status or denials. Submits appeals in the event of denial of prior authorizations or denial of payment following procedures. Set up peer to peer calls with clinical providers and insurance companies, as needed. Calculate and document patient out of pocket estimates and provide to patient. Assists Supervisor with special projects and/or tasks. Assists Authorization Specialist I with complex cases or questions. Serves as back-up to Authorization Specialist III. Performs other job duties as assigned. Please note: While this position is primarily remote, candidates must be in a Columbia University approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the employee's responsibility and not be reimbursed by the company. Job Qualifications: High school graduate or GED certificate is required. A minimum of 1-year experience in a physician s billing or third payer environment. Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations. Candidate must demonstrate strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner. Must demonstrate effective communication skills both verbally and written. Ability to multi-task, prioritize, document, and manage time effectively. Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.) Functional proficiency and comprehension of medical terminology. Experience in Epic and or other electronic billing systems is preferred. Knowledge of medical terminology, diagnosis and procedure coding is preferred. Previous experience in an academic healthcare setting is preferred. Hourly Rate Ranges: $23.69 - $32.00 Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education. 61st Street Service Corporation At 61 st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle. We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.

Patient Registration Specialist Hospital Registration and Check In - Remote, work from home Who We Are vRS Corporation provides virtual registration services to hospitals and clinics. In a time of shortage of staffing, changing work environments and a desire for work from home jobs, vRS has developed a system that allows medical providers to staff their registration areas through technology and onsite Virtual Interactive and Engagement Workstaions (V.I.E.W.) TM that connect to virtual registration agents working from home. Through video technology we are able to do everything an onsite in person registration specialist would be able to do. Job Summary The Patient Registration Specialist is responsible for assisting patients during the on-site registration and arrival process for scheduled and unscheduled visits as well as completing financial clearance functions. This individual completes the registration for visits by collecting accurate demographic information, insurance information, and collecting patient liability (if known) at the time of service. This individual is also responsible for financial clearance functions on assigned scheduled accounts during registration downtimes. The Patient Registration Specialist greets and serves patients and internal team members in a professional, friendly, and respectful manner to promote positive encounters. What We'll Love About You Excellent verbal and written communication skills. Excellent interpersonal and customer service skills. Excellent organizational skills and attention to detail. Education Required: High school diploma or equivalent Experience Preferred: At least 1-2 years prior registration experience Functional computer skills and comfort using different programs long with computer navigation combined with excellent typing skills. Ability to multi-task in a fast-paced environment Ability to work with a large number of people/calls daily and covering urgent requests Ability to maintain strict confidentiality Licensure/Certification/Registration CHAA preferred Why Work Here Competitive pay & Full Time 40 hours/week PTO and sick time after 90 days Individual Coverage Healthcare Reimbursement Arrangement (ICHRA) Healthcare reimbursement program for medical insurance 401k plan Company-sponsored life insurance with supplemental buy up options Great co-workers Remote Work Technical Requirements Minimum internet bandwidth requirements - Minimum requirements assume that the entire bandwidth will be available and used for the individual working from home. If other users are using the bandwidth, it is the individual's responsibility to ensure these minimum requirements are met for their work use. 25 Mbps download speed 5 Mbps upload speed Use ***************************** to test speed RTT (round trip time) 100ms or less to “AWS Workspaces US East (N. Virginia)” Please use ************************************************ to test you RTT Must be able to hardline into your home router. No Wi-Fi connections. If connection distance is more that 12 feet away from home router and network cable, it will need to be special ordered and we will need to know the specific length. Internet Service Provider (ISP) must be through Coax, DSL, or Fiber connections. No Satellite or wireless via cell phone providers is permitted. Willing to install necessary authenticator application for multi-factor authentication on your smartphone including Microsoft Authenticator App and Imprivata ID App as well as any others needed based on client access requirements. Will be required to be on camera for your shift Remote Work Physical Space Requirements Employees working remotely are required to maintain a space that is a closed space where people other than the employee will not be accessing the space during working hours and otherwise within the household cannot hear conversations going on between the employee and clients or patients. The employee can not have children or other family members present during work and will need to be able to focus on work 100%. No PHI or HIPAA data may be printed or written down in home locations. Employees need to utilize electronic resources and system to contain PHI and HIPAA data for security and compliance. Company-provided computers and equipment may not be used by anyone other than the employee and will need to be secured in a way where others do not have access to the equipment, preferably in a locked office. Employees need to have a quiet, secure work space that is free from outside noise and distractions while working in order to be able to focus on work and maintain confidentiality. We are always looking for great people to join our team. If you are passionate about customer service, enjoy working with a fantastic team, and are motivated to make a difference in patients' lives every day, then apply today with vRS! *******************************************

Pay Range: $21.00 - $25.00 per hour Schedule: Full-time, 5 days/week (8:30 AM - 5:00 PM PST) with weekend rotation or staggered schedule including one fixed weekend day About Us At Seaport Scripps Home Health, our mission is simple yet powerful: to provide LIFE CHANGING SERVICE to our patients and their families. We believe a career in healthcare is one of the noblest professions, and exceptional clinical operations leadership makes home health possible. Our team is committed to delivering superior clinical outcomes and outstanding patient and family satisfaction. Through dedication and compassion, we strive to be the provider of choice in the communities we serve. We foster a culture that values: Celebration of successes and making work enjoyable Highest standards of care and professionalism Continuous learning and growth Respect and empathy for others Innovation and good judgment And most importantly, we put employees first, because we know great care starts with a great team. Job Summary The Authorization Specialist plays a key role in ensuring smooth operations by verifying insurance eligibility, obtaining authorizations, and managing related clerical tasks. This position supports intake processes, maintains accurate clinical records, and fosters positive relationships with providers and referral sources. Key Responsibilities Verify insurance eligibility and confirm payer sources for all referrals Manage the authorization process, including monitoring calls and requests from providers Obtain and provide clinical information needed for authorizations Communicate authorization status to field and scheduling staff Provide backup support to Intake and Scheduling Coordinators Protect patient and organizational confidentiality Maintain knowledge of state, federal, and CHAP documentation regulations Qualifications Minimum 1 year of experience in insurance eligibility and authorizations (home health experience preferred) Knowledge of information systems and corporate business management Familiarity with governmental regulations Strong communication and public relations skills Ability to work independently with organization, flexibility, and cooperation About Seaport Scripps Home Health We are part of the Pennant Group, a nationwide network with 300+ locations. This gives us the stability of a proven healthcare leader while allowing us to operate locally with autonomy and innovation. Our Core Values guide everything we do: Celebration Accountability Passion for Learning Love One Another Intelligent Risk Taking Customer Second Ownership Benefits Competitive compensation Health, dental, vision, life, and disability insurance Pre-tax healthcare and dependent care flexible spending accounts 401(k) plan with generous company match Critical illness benefit Tuition reimbursement Paid time off Employee assistance program Seaport Scripps Home Health is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, or other protected characteristics. The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at ****************************

Job Description Job Summary: Obtains authorizations and referrals for surgical procedures and offsite diagnostic imaging. Creates medical and dental surgical estimates. Qualifications & Additional Characteristics: Strong interpersonal skills. The ability to relate effectively with physicians and staff, as well as outside business associates at multiple levels. Computer literate and knowledge of practice management software, insurance, and billing software. Epic knowledge preferred. Use of appropriate e-mail and internet practice applications. Basic knowledge of insurance pre-authorization process. Understanding of Managed Care contractual policies. Knowledge of CPT and ICD-10-CM coding. Oral maxillofacial surgery preferred. Responsibilities include, but are not limited to, the following: Ensures insurance carrier documentation requirements are met for pre-authorizations as it pertains to procedural and/or surgery needs. Initiates expedited reviews with payers when necessary to ensure authorization is in place prior to, or at the time of service, and communicates late notifications or risk of no auth situation to Surgery Schedulers as soon as identified. Researches and develops resources that create timely and efficient workflow. Routinely monitors cases pending or not yet started/complete, being attentive to payer specific processing time. Maintains excellent communication and positive rapport with all points of contact both internally and externally. Documents pertinent discussions and details of correspondence in all applicable systems to provide tracking and point of reference. Properly handle denied authorization cases and seek resolution through involved parties. Create medical and dental surgical estimates based on health insurance coverage. Attend all Billing Department and staff meetings. Education and Experience Requirements: High school degree or equivalent Degree and/or training in medical billing and coding Minimum of three years in the health care field Strong background and experience in understanding patient accounts as to private pay, health insurance, billing, and collection processes. Independent medical coding experience a must; Certified Medical Coder a plus. Typical Physical Demands: Work may require sitting for long periods of time, stooping, bending, and stretching. This position requires manual dexterity sufficient to operate a keyboard, computer, telephone, calculator, copier, and such other office equipment, as necessary. Employee must have normal range of hearing and eyesight. Position also requires viewing computer screens and typing for long periods of time and working in a fast-paced environment. Typical Working Conditions: Work is performed in a billing area and involves frequent contact with patients, insurance carriers and physicians. Work may be stressful at times. Monday - Friday 8am - 5pm Option to work remotely 2x per week after 90 day probationary period.

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world! Job Title: Authorization Specialist (Remote in Wisconsin & Michigan) Cost Center: 101651135 Insurance Verification Scheduled Weekly Hours: 40 Employee Type: Regular Work Shift: Mon-Fri; 8:00 am - 5:00 pm (United States of America) Job Description: Wisconsin and Michigan residents only eligible to apply JOB SUMMARY The Authorization Specialist is a healthcare professional responsible for reviewing patient medical records to determine if a prescribed treatment, procedure, or medication requires prior authorization from the insurance company, ensuring that the requested care is deemed medically necessary and covered under the patient's benefits before it can be administered; this involves verifying patient eligibility, contacting insurance companies to obtain authorization, and managing the process to minimize delays in patient care. An Authorization Specialist works in a fast-paced environment with high call volumes, requiring strong organizational skills and the ability to manage multiple tasks simultaneously. JOB QUALIFICATIONS EDUCATION For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation. Minimum Required: None Preferred/Optional: Successful completion of post-secondary courses in Medical Terminology and Diagnosis and CPT Coding, and Anatomy & Physiology. Graduate of a Medical Assistant, Health Unit Coordinator or Health Care Business Service program. EXPERIENCE Minimum Required: Two years' experience in a medical business office or health care setting involving customer service or patient-facing responsibilities, or equivalent experience. In addition to the following: * Medical knowledge: Understanding of basic medical terminology, disease processes, and treatment options to accurately assess medical necessity. * Insurance knowledge: Familiarity with different insurance plans, benefit structures, and prior authorization guidelines. * Excellent communication skills: Ability to effectively communicate with healthcare providers, insurance companies, and patients to clarify information and address concerns. * Attention to detail: High level of accuracy in data entry and review of medical records to ensure correct prior authorization requests. * Problem-solving skills: Ability to identify potential issues with prior authorization requests, navigate complex situations, and find solutions to ensure timely patient care. Preferred/Optional: None. CERTIFICATIONS/LICENSES The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position. Minimum Required: None. Preferred/Optional: None. Wisconsin and Michigan residents only eligible to apply Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first. Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program. Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.