Staffing for Doctors
Healthcare
BilingualPriorAuthorizationSpecialist
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“Bilingual Prior Authorization Specialist at Staffing for Doctors. Skills: Prior Authorizations, Denial Appeals, Insurance Verification, Utilization Tracking. Submit prior authorizations. Secure prior authorizations”
What You'll Achieve.
Ensure procedures authorized; Ensure medications authorized; Ensure diagnostics authorized; Prevent treatment delays; Protect practice from claim rejections
Industry & Context.
Managing denial appeals; Overturning adverse determinations
Quiet home office setup, Secure home office setup, HIPAA compliant home office setup
What They're Looking For.
Must Have
2+ years prior authorization experience, 2+ years insurance appeals experience, Bilingual fluency (English/Spanish), Clear English verbal communication, Operational understanding of CPT codes, Operational understanding of ICD-10 codes, Understanding of medical necessity documentation rules, Agreement to work under automated time-tracker, Maintain quiet home office setup, HIPAA compliant home office setup
Nice to Have
ModMed (Modernizing Medicine) / EMA EHR familiarity, Optum VoIP phone system experience, Surgical specialties authorization experience, Advanced diagnostic imaging authorization experience
What You'll Do.
Submit prior authorizations
Secure prior authorizations
Review clinical charts
Ensure medical necessity documentation
Manage authorization tracking pipelines
Follow up with insurance medical directors
Follow up with utilization management teams
Prevent treatment delays
Research appeals for denied authorizations
Write appeals for denied authorizations
Submit appeals for denied authorizations
Leverage provider clinical notes
Overturn adverse determinations
Execute eligibility checks
Verify coverage limitations
Track policy exclusions
Track pending authorization expiration dates
Track utilization caps
Track required renewal cycles
Protect practice from retroactive claim rejections
Manage outbound call workflows
Manage inbound call workflows
Convey coverage updates to patients
Partner with clinicians
Partner with providers
Secure required clinical notes
Schedule peer-to-peer reviews
Obtain updated CPT codes
Obtain updated ICD-10 codes
Document authorization confirmation numbers
Document approved lines of service
Document payer correspondence paths
Document in patient EMR record
How You'll Work.
Team & Collaboration
Partner with clinicians; Partner with providers
Communication Scope
Accent-free verbal English; Professional phone demeanor; High-clarity phone support; Empathy; Extreme professionalism
Full Job Description
We are seeking a highly organized, systematic, and articulate **Virtual Prior Authorization Specialist** to lead the clinical administrative gateway for a fast-paced medical practice. This role is specifically designed for a dedicated insurance navigation expert who understands how to bridge the gap between complex payer guidelines, clinical documentation, and seamless patient scheduling. The primary anchor of this position is **Obtaining Prior Authorizations and Managing Denial Appeals**. You will be responsible for ensuring that all upcoming procedures, specialty medications, and advanced diagnostics are fully authorized before services are rendered. Because you will be communicating extensively with Texas-based insurance providers, clinical staff, and patients, **you must possess exceptional, accent-free verbal English clarity** , an authoritative command of insurance jargon, and a polished, professional phone demeanor. ** Core Responsibilities: Prior Authorizations & Denial Appeals (Primary Focus)** * **End-to-End Authorization Management:** Submit and successfully secure prior authorizations for complex procedures, specialty medications, high-level imaging, and specialty referrals. * **Clinical Review Coordination:** Review clinical charts within **ModMed/EMA** to ensure medical necessity documentation perfectly supports specific payer requirements prior to submission. * **Proactive Payer Follow-Up:** Manage authorization tracking pipelines aggressively, following up with insurance medical directors and utilization management teams to prevent treatment delays. * **Appeals & Denials Processing:** Research, write, and submit technical appeals for denied authorizations, leveraging provider clinical notes to overturn adverse determinations. **Insurance Verification & Utilization Tracking** * **Front-End Benefit Auditing:** Execute deep-dive eligibility checks and verify coverage limitations, tracking specific deductibles and policy exclusions. * **Expiration Safegu
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