授权专员 | 美国医疗保健 | EST工作时间 | 远程
Authorizations Specialist | US Healthcare | EST Hours | Remote
ISTA Personnel Solutions是一家快速发展的全球BPO公司。我们不是招聘代理公司。我们作为美国客户的团队延伸，提供高质量的运营支持，注重精准、效率和专业性。
我们正在为一家快速增长的美国医疗健康公司招聘一名授权专员，加入他们的团队，支持保险授权、付款人要求、患者福利及相关医疗行政流程。
作为授权专员，您将从提交到批准、拒绝或重新授权的整个过程中管理保险授权请求。您将与医疗保健提供者、保险公司、计费和药房团队以及内部部门密切合作，确保授权和付款人要求准确完成，并在规定时间内完成。
此职位适合有医疗保健保险授权、医疗援助、福利验证、医疗计费、索赔、转诊或相关医疗行政经验的人士，要求高度组织、注重细节、积极主动，并能在快节奏环境中处理多个案件和跟进工作。
请注意：
- 工作时间：周一至周五 | 美国东部时间上午09:00 – 下午18:00（南非时间为下午15:00 – 凌晨00:00，受夏令时影响）。可能需要在周五灵活调整，如需延长时间，可能会在一周内分散安排。
- 公共假期：该职位需要在南非和美国公共假期工作（南非公共假期的补偿按照《劳动法》规定）。
- 网络要求：必须使用固定光纤线路，上传和下载速度至少25 Mbps，并具备有线以太网连接。没有固定光纤线路的申请人无法被考虑。
- 电力备份：需要可靠的备用电源以应对停电或限电情况。没有电力备份的申请人无法被考虑。
- 工作环境：完全远程
主要职责：
- 从提交到批准、拒绝或重新授权的整个过程中管理保险授权请求。
- 审核患者信息和临床文档，确保满足付款人和授权要求。
- 监控授权状态、过期日期和即将进行的预约，以识别潜在的缺口或延误。
- 协调单例协议（SCAs）并为相关团队提供状态更新。
- 完成重新授权
查看英文原文
ISTA Personnel Solutions is a fast-growing, global BPO company. We are not a recruitment agency. We operate as a dedicated extension of our U.S.-based clients’ teams, delivering high-quality operational support with precision, efficiency, and professionalism.
We are recruiting on behalf of a growing U.S.-based healthcare and wellness company for an Authorizations Specialist to join their team and support insurance authorizations, payer requirements, patient benefits, and related healthcare administrative processes.
As an Authorizations Specialist, you will manage insurance authorization requests from submission through approval, denial, or reauthorization. You will work closely with healthcare providers, insurance carriers, billing and pharmacy teams, and internal departments to ensure authorization and payer requirements are completed accurately and within required timeframes.
This role is well suited to someone with experience in healthcare insurance authorizations, medical aid, benefits verification, medical billing, claims, referrals, or related healthcare administration, who is highly organised, detail-oriented, proactive, and comfortable managing multiple cases and follow-ups in a fast-paced environment.
PLEASE NOTE:
- Working Hours: Monday – Friday | 09:00 AM – 18:00 PM EST (15:00 PM – 00:00 AM South African time – subject to daylight savings). Flexibility may be required on Fridays, with later hours potentially being spread across the week when required.
- Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA).
- Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered.
- Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered.
- Work Environment: Fully remote
Key Responsibilities:
- Managing insurance authorization requests from submission through approval, denial, or reauthorization.
- Reviewing patient information and clinical documentation to ensure payer and authorization requirements are met.
- Monitoring authorization statuses, expiration dates, and upcoming appointments to identify potential gaps or delays.
- Coordinating Single Case Agreements (SCAs) and providing status updates to relevant teams.
- Completing required online enrolments relating to compliance programs, patient benefits, and payer or treatment requirements.
- Managing payer-specific requirements, including TRICARE referrals and authorizations.
- Processing and monitoring pharmacy prior authorizations and medication-related approvals.
- Maintaining accurate authorization, payer, enrolment, and patient information within Salesforce and other relevant systems.
- Preparing and managing required evaluation and billing-related documentation.
- Communicating with insurance carriers, billing partners, healthcare providers, pharmacy partners, and internal teams regarding authorization, enrolment, and benefits requirements.
- Proactively following up on outstanding requests, missing documentation, denials, enrolments, and other barriers to treatment.
- Completing required reports and assisting with monitoring authorization and patient scheduling activity.
- Assisting with the development and documentation of authorization, enrolment, and payer-specific workflows.
- Supporting 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.
- A 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.
- Able 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.
If you are not contacted within 14 working days, please consider your application unsuccessful.
Originally posted on Himalayas