Prior Authorization Specialist - Remote | Philippines

Join Our Team at Skin and Cancer Institute!

Are you passionate about dermatology and skin health? Do you thrive in a dynamic, patient-focused environment? Skin and Cancer Institute is looking for dedicated professionals to join our team!

Why Join Us?

At Skin and Cancer Institute, we are committed to excellence in dermatology, skin cancer treatment, and cosmetic procedures. We offer a supportive and collaborative work culture where your skills and dedication make a real impact.

Summary of Position

• Reports to: Authorization Manager
• Work schedule: U.S. Pacific Time, Monday to Friday (maximum of 40 hours per week)
• Work Category: Full-time, Remote

The Prior Authorization Specialist determines authorization requirements and submits, tracks, renews, and documents prior authorization requests for medical services, procedures, and specialty treatments. This position coordinates with patients, providers, payers, scheduling teams, and internal departments to support timely access to care and compliance with payer requirements.

The Prior Authorization Specialist owns submission, follow-up, approval documentation, renewal, denial escalation, and closure of authorization requests. Clinical decisions, coding determinations, peer-to-peer discussions, and financial counseling remain with the appropriately authorized teams. Success requires accuracy, strong communication, and effective management of high-volume work

WHAT YOU'LL DO:

Authorization Management

• Review physician orders, treatment plans, procedures, surgeries, and specialty services to determine authorization requirements.
• Obtain prior authorizations and precertifications from commercial, Medicare, Medicaid, and managed care plans and confirm eligibility or referral information through established workflows.
• Submit complete and accurate requests with required clinical documentation and the ordered codes, units, frequency, rendering provider, servicing location, and requested dates.
• Monitor pending requests, follow up at required intervals, and respond to requests for additional information within assigned timeframes.
• Maintain authorization tracking systems and update EMR records with all authorization information.
• Coordinate peer-to-peer reviews by notifying the ordering provider or designated clinical staff, communicating payer deadlines, and documenting outcomes; coordinate appeals within departmental policy and assigned authority.
• Identify authorization expiration dates and obtain extensions, renewals, or updated approvals as needed.

Insurance Verification and Benefits Coordination

• Confirm eligibility, benefits, coverage limitations, and referral information through established workflows and focus on authorization requirements.
• Review payer policies and medical necessity guidelines to determine coverage criteria.
• Obtain accurate benefit information and communicate financial obligations to patients when necessary.
• Refer patients to the appropriate financial counseling, patient-assistance, clinical, or leadership resource when services are denied, excluded, or not covered.

Patient and Provider Communication

• Serve as the primary point of contact regarding authorization status updates.
• Communicate effectively with patients regarding authorization requirements, approvals, denials, delays, and next steps.
• Collaborate with providers and clinical staff to obtain additional documentation required by insurance carriers.
• Confirm that approvals match the scheduled service and coordinate scheduling readiness with surgery, Mohs, pathology, cosmetics, pharmacy, and clinical departments.
• Respond promptly to internal messages, payer requests, patient inquiries, and communication platforms utilized by the organization.

Documentation and Compliance

• Document the authorization number, approved services or codes, units or visits, servicing provider and location, effective dates, limitations, status, and payer determination notice in ModMed/EMA and designated systems.
• Ensure compliance with HIPAA, Medicare, Medicaid, commercial payer regulations, and organizational policies.
• Maintain confidentiality of patient and organizational information.
• Audit authorization records for completeness and accuracy.
• Stay current on changing payer requirements, authorization processes, and regulatory updates.

Operational Excellence

• Meet established productivity, quality, turnaround time, and accuracy standards.
• Assist with departmental workflow improvements and process optimization initiatives.
• Participate in training, onboarding, and mentoring new team members as assigned.
• Support organizational growth initiatives, acquisitions, and departmental integration efforts when needed.
• Perform other duties and special projects as assigned.

WHAT WE'RE LOOKING FOR

Required Skills / Abilities:

• Strong knowledge of healthcare insurance plans, prior authorization procedures, and reimbursement processes.
• Working knowledge of Medicare, Medicaid, commercial insurance plans, HMOs, PPOs, and specialty pharmacy processes.
• Excellent verbal and written communication skills.
• Strong customer service and patient relations skills.
• Advanced organizational and time management abilities.
• Ability to manage multiple priorities and deadlines simultaneously.
• Strong analytical and problem-solving skills.
• High degree of accuracy and attention to detail.
• Ability to work independently with minimal supervision.
• Ability to maintain professionalism under pressure.
• Strong collaboration and teamwork skills.
• Proficiency with Microsoft 365 applications including Outlook, Word, Excel, and Teams.
• Experience with electronic medical records and practice management systems; EMA/Modernizing Medicine experience preferred.
• Ability to interpret medical documentation, payer guidelines, and insurance policies.
• Knowledge of HIPAA and healthcare compliance requirements.

Education & Experience

Required

• High School Diploma or equivalent.
• Minimum of 2 years of healthcare prior authorization, insurance verification, medical billing, revenue cycle, or related healthcare administrative experience.
• Experience working with insurance carriers and payer authorization processes.
• Proficiency with Microsoft 365 and electronic health record systems.

Preferred

• Associate's degree in healthcare administration, Business Administration, Medical Office Administration, or related field.
• 3+ years of prior authorization experience within a dermatology, oncology, surgical, or multi-specialty practice.
• Experience with Modernizing Medicine (EMA), ModMed, NextGen, or similar EMR platforms.
• Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), or other relevant healthcare certification.
• Remote healthcare operations experience.

Equipment & Software Operation

The incumbent in this position may operate any/all of the following equipment:

• Microsoft Outlook, Word, Excel, PowerPoint, fax, email, phone, Microsoft Teams, Zoom Call Center, EMA, Klara and Next Patient

WHAT WE OFFER

Placement within the range will be based on objective, job-related factors, which may include relevant experience, education, training, skills, certifications, internal equity, and business considerations

• Competitive salary
• Night shift differential pay
• Statutory benefits
• Paid time off
• Professional development opportunities
• Supportive and fair work environment

Apply Today! Be a part of a dynamic team that’s transforming skin health. We can't wait to meet you!

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