Prior Authorization Specialist

Job not on LinkedIn

🕒 July 23

🇵🇭 Philippines – Remote

💵 $4 - $5 / hour

⏳ Contract/Temporary

🟢 Junior

✨ Prior Authorization Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 15%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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EMS

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1964

🏥 Healthcare

🏭 Manufacturing

💊 Pharmaceuticals

Healthcare • Manufacturing • Pharmaceuticals

EMS is the largest pharmaceutical laboratory in Brazil, recognized for its commitment to providing effective and affordable health solutions. With over 55 years in the industry, EMS operates in more than 40 countries and offers a diverse portfolio of products, including innovative treatments for chronic conditions such as obesity and diabetes. The company also emphasizes social responsibility and quality, investing in research and development to ensure high standards in the medications it produces.

📋 Description

• Responsible for coordinating the intake, insurance authorization, and referral processes for OMHC and Freedom Healthcare Primary Care Freestanding General Clinic • Ensure that all required documentation is complete, prior authorizations are submitted accurately and on time • Track authorization requests, manage renewals, verify insurance requirements, and maintain accurate records in compliance with Medicaid, Managed Care Organizations (MCOs), COMAR, CARF, and organizational standards • Collect, review, and verify intake documentation for new client referrals • Review insurance eligibility, benefits, and payer-specific authorization requirements • Prepare, submit, and track initial and continuing prior authorization requests • Monitor authorization status and proactively follow up with payers to ensure timely approvals • Initiate renewal requests before authorization expiration dates to prevent service interruptions • Communicate with providers and clinical staff to obtain missing documentation, signatures, or clinical information • Update electronic health records (EHRs), payer portals, and internal tracking systems with authorization status • Ensure all authorization requirements are completed at least three (3) business days prior to scheduled services whenever possible • Notify clinical, scheduling, and administrative teams of authorization approvals, denials, or delays • Assist with intake coordination and referral management as needed • Maintain organized electronic records to support audit readiness and regulatory compliance • Assist with insurance verification and benefit confirmation during periods of high volume • Participate in quality improvement initiatives to improve authorization turnaround times and documentation accuracy • Support compliance reporting, payer audits, and other departmental projects as assigned • Perform other duties as assigned.

🎯 Requirements

• High school diploma or equivalent required • Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred • Minimum of one (1) to two (2) years of experience in healthcare administration, medical prior authorizations, insurance verification, or patient intake coordination • Experience with outpatient mental health (OMHC), behavioral health, psychiatric rehabilitation (PRP), or primary care authorizations preferred • Experience working with Maryland Medicaid, Managed Care Organizations (MCOs), or commercial insurance authorization processes preferred • Experience using electronic health record (EHR) systems and payer portals is highly desirable • Knowledge of prior authorization and insurance verification processes • Familiarity with Maryland Medicaid and Managed Care Organization (MCO) authorization requirements • Understanding of outpatient behavioral health and medical terminology • Strong attention to detail and organizational skills • Excellent time management and ability to manage multiple authorization requests simultaneously • Strong written and verbal communication skills • Ability to prioritize tasks and meet strict deadlines • Proficiency with electronic health records, payer portals, Microsoft Office, and Google Workspace • Strong problem-solving and follow-up skills • Ability to work independently in a fast-paced remote environment • High level of professionalism, confidentiality, and integrity.

🏖️ Benefits

• Independent contractor position; not eligible for employee benefits

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