Authorizations Specialist, US Healthcare

🔥 0 minutes ago

🇿🇦 South Africa – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.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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iSTA Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

iSTA Solutions is your remote healthcare operations partner specializing in off-site staffing solutions. With over 20 years of experience, we focus on enhancing operational efficiency for businesses, particularly in the healthcare sector, by providing customized remote teams that take on tasks ranging from customer service to data entry. Our goal is to support organizations in scaling their operations seamlessly while achieving significant cost savings and improved productivity.

📋 Description

• Manage insurance authorization requests from submission through approval, denial, or reauthorization • Review patient information and clinical documentation to ensure payer and authorization requirements are met • Monitor authorization statuses, expiration dates, and upcoming appointments to identify gaps or delays • Coordinate Single Case Agreements (SCAs) and provide status updates to relevant teams • Complete online enrolments relating to compliance programs, patient benefits, and payer or treatment requirements • Manage payer-specific requirements, including TRICARE referrals and authorizations • Process and monitor pharmacy prior authorizations and medication-related approvals • Maintain accurate authorization, payer, enrolment, and patient information in Salesforce and other relevant systems • Prepare and manage evaluation and billing-related documentation • Communicate with insurance carriers, billing partners, healthcare providers, pharmacy partners, and internal teams • Follow up on outstanding requests, missing documentation, denials, enrolments, and other treatment barriers • Complete required reports and assist with monitoring authorization and patient scheduling activity • Assist with developing and documenting authorization, enrolment, and payer-specific workflows • Support system and workflow improvement initiatives to increase efficiency and reduce delays in patient care

🎯 Requirements

• Previous experience in healthcare insurance authorizations, medical aid authorizations, benefits verification, medical billing, claims, utilization management, or related healthcare administration is preferred • Experience working with medical aids, insurance providers, payer portals, or online healthcare enrollment systems is advantageous • Good understanding of insurance benefits, prior authorizations, referrals, claims, and payer requirements is preferred • Strong organisational and time-management skills, with excellent attention to detail and accuracy • Strong written and verbal communication skills • Ability to manage multiple cases, priorities, deadlines, and follow-ups simultaneously • Strong problem-solving and critical-thinking skills • Proactive and self-motivated, with the ability to independently follow up on outstanding tasks and see them through to completion • Comfortable working with technology and learning new systems; Salesforce experience is a plus • Ability to work collaboratively with clinical, administrative, billing, pharmacy, and other internal teams • Ability to maintain confidentiality and appropriately handle sensitive patient information • Adaptable and comfortable working in an environment where processes and workflows may continue to develop and improve • Previous experience supporting a U.S. healthcare client or working with U.S. insurance/payer requirements is advantageous • Monday–Friday availability for 09:00–18:00 EST / 15:00–00:00 South African time, subject to daylight savings • Ability to work on South African and U.S. public holidays • Fixed fibre line with minimum 25 Mbps upload and download speeds and wired Ethernet capability • Reliable power backup for load shedding or outages

🏖️ Benefits

• Compensation for South African public holidays in accordance with the BCEA • Fully remote work arrangement