Prior Authorization Specialist
Winning Assistants • Philippines
No Relocation
Posted: February 24, 2026
Job Description
Job Title: Prior Authorization Specialist
Job Code: [JW-BODB]
Position Type: Full-time
Work Hours: 8:00 AM - 5:00 PM Eastern Standard Time, Monday - Friday
Salary rate: $5-$7per hour
Key Responsibilities
- Gather clinical documentation, confirm medical necessity criteria, submit requests via payer portals (e.g., Availity), CoverMyMeds, fax, or phone.
- Monitor status queues daily, follow up within payer timelines, and manage renewals/reauthorizations proactively.
- Verify eligibility and benefits through online portals, clearinghouses, and outbound payer calls.
- Confirm and document: copays, deductibles, coinsurance, OOP max, plan type, effective dates, coverage limitations, and authorization/referral requirements.
- Flag and resolve discrepancies (inactive coverage, wrong member ID, plan mismatches) before service dates to prevent denials.
- Review EOB/ERA/denial messages, identify root cause (eligibility, auth, coding, medical necessity, timely filing, documentation, referral).
- Coordinate corrections, resubmissions, peer-to-peer requests, and formal appeals as needed.
Experience Requirements:
- Healthcare-related education or experience (nursing, pharmacy, medical admin, billing, etc.)
- 1–2+ years experience in prior authorizations, medical billing, pharmacy coordination, or insurance verification
- Comfortable with insurance portals and payer processes (e.g., Availity, CoverMyMeds) and EHR systems
- Knowledge of eligibility/benefits and denials/appeals workflows
- Strong communication, organization, and attention to detail
- Able to work independently in a fast-paced setting
- Follows HIPAA, payer rules, and protects patient confidentiality
Basic requirements
- Must be proficient in speaking and writing English very clearly
- Must have relevant work experience
- Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory]
- Must be available for video meetings with your camera on (when needed)
Technical requirements
- Device: Reliable laptop or desktop computer.
- Internet: High-speed connection (minimum 10 Mbps).
- Audio: Noise-canceling headset.
- Video: Webcam for virtual meetings.
- Workspace: Quiet, professional environment.
Additional Content
Job Title: Prior Authorization Specialist
Job Code: [JW-BODB]
Position Type: Full-time
Work Hours: 8:00 AM - 5:00 PM Eastern Standard Time, Monday - Friday
Salary rate: $5-$7per hour
Key Responsibilities
- Gather clinical documentation, confirm medical necessity criteria, submit requests via payer portals (e.g., Availity), CoverMyMeds, fax, or phone.
- Monitor status queues daily, follow up within payer timelines, and manage renewals/reauthorizations proactively.
- Verify eligibility and benefits through online portals, clearinghouses, and outbound payer calls.
- Confirm and document: copays, deductibles, coinsurance, OOP max, plan type, effective dates, coverage limitations, and authorization/referral requirements.
- Flag and resolve discrepancies (inactive coverage, wrong member ID, plan mismatches) before service dates to prevent denials.
- Review EOB/ERA/denial messages, identify root cause (eligibility, auth, coding, medical necessity, timely filing, documentation, referral).
- Coordinate corrections, resubmissions, peer-to-peer requests, and formal appeals as needed.
Experience Requirements:
- Healthcare-related education or experience (nursing, pharmacy, medical admin, billing, etc.)
- 1–2+ years experience in prior authorizations, medical billing, pharmacy coordination, or insurance verification
- Comfortable with insurance portals and payer processes (e.g., Availity, CoverMyMeds) and EHR systems
- Knowledge of eligibility/benefits and denials/appeals workflows
- Strong communication, organization, and attention to detail
- Able to work independently in a fast-paced setting
- Follows HIPAA, payer rules, and protects patient confidentiality
Basic requirements
- Must be proficient in speaking and writing English very clearly
- Must have relevant work experience
- Be able to submit an NBI clearance and/or Local Police Clearance background check before onboarding [mandatory]
- Must be available for video meetings with your camera on (when needed)
Technical requirements
- Device: Reliable laptop or desktop computer.
- Internet: High-speed connection (minimum 10 Mbps).
- Audio: Noise-canceling headset.
- Video: Webcam for virtual meetings.
- Workspace: Quiet, professional environment.