Position: Medical Authorization Specialist
Hours: Full-Time
Start Date: Immediate
Job Overview:
We are seeking a dedicated and experienced Medical Authorization Specialist to join our team. The ideal candidate will be responsible for obtaining prior authorizations for medical services, surgeries, imaging, durable medical equipment (DME), injections, physical therapy, and other specialty services. A strong understanding of medical terminology, insurance company protocols, and U.S. healthcare authorization requirements is essential. Experience in orthopedics and familiarity with Eclinical EHR is highly desirable.
Key Responsibilities:
- Obtain prior authorizations for office visits, surgeries, imaging, injections, DME, physical therapy, and specialty services.
- Verify patient eligibility, benefits, and authorization requirements with insurance companies and IPAs.
- Submit and monitor authorization requests through payer portals, phone, and fax.
- Follow up on pending authorizations to ensure timely approvals.
- Communicate authorization status with patients, providers, surgery schedulers, referral coordinators, and clinic staff.
- Intake of all calls related to authorizations.
- Review medical records to ensure documentation supports authorization requests.
- Resolve authorization denials and requests for additional clinical information.
- Utilize Eclinical EHR to document authorization activity accurately.
- Maintain excellent turnaround times while managing a high-volume workload.
- Provide exceptional customer service while working collaboratively with internal departments.
Qualifications:
- Minimum 2 years of experience in medical prior authorizations for a U.S. medical practice.
- Fluent in both English and Spanish (required).
- Strong knowledge of commercial insurance, Medicare, Medicaid/Medi-Cal, HMOs, PPOs, Workers' Compensation, and IPA authorization processes.
- Understanding of medical terminology.
- Experience working with payer portals and insurance websites.
- Strong organizational skills with the ability to prioritize multiple tasks and meet deadlines.
- Excellent communication and follow-up skills.
- Excellent phone etiquette.
- Ability to work independently in a fast-paced remote environment.
- Experience in the orthopedic field is highly preferred.
- Proficiency with Eclinical EHR is a plus.
Join our team and make a difference in the lives of our patients every day!
LA Bone and Joint Institute is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Please note, pay is posted as MXN and not USD.
Job Type: Full-time
Work Location: Remote (Mexico)
Job Type: Full-time
Pay: From $102.00 per hour
Work Location: Remote
