Insurance Specialist - Prior Authorization (Remote) - Eastern Time zone

About Us: 

Meduit is a national leader in healthcare revenue cycle management, supporting hospitals and physician practices in 48 states. We focus on optimizing payments, allowing clients to focus on patient care, and pride ourselves on our core values: Integrity, Teamwork, Continuous Improvement, Client-Focused, and Results-Oriented. Learn more at www.meduitrcm.com. 

About the Role: 

The Insurance Specialist - Prior Authorization is responsible for obtaining prior authorizations, verifying insurance benefits, and ensuring compliance with payer requirements before services are delivered. This role works closely with patients, providers, clinical teams, and insurance carriers to secure approvals, resolve authorization issues, and support accurate reimbursement.

Success in this role requires strong knowledge of insurance verification, payer guidelines, eligibility requirements, authorization processes, and healthcare revenue cycle operations.

Key Responsibilities: 

• Verify patient insurance eligibility, benefits, and coverage requirements.
• Obtain prior authorizations and referrals from insurance carriers in accordance with payer requirements.
• Communicate with insurance companies, provider offices, and patients to collect information necessary for authorization approval.
• Research and resolve authorization-related issues that could impact patient access to services.
• Review accounts for medical necessity, payer requirements, and benefit limitations.
• Document authorization activity and maintain accurate account records.
• Update patient demographic, insurance, and payer information as needed.
• Monitor authorization status and ensure timely follow-up on pending requests.
• Utilize payer portals, eligibility tools, and healthcare software systems to support authorization activities.
• Maintain established productivity, quality, and accuracy standards.
• Collaborate with operational, billing, and clinical teams to support reimbursement and patient access goals.

Required Qualifications: 

• High School Diploma or GED
• 2+ years of prior authorization, insurance verification, medical billing, patient access, or healthcare revenue cycle experience
• Experience with Medicare, Medicaid, and commercial payers
• Experience with Workers' Compensation pre-access or authorization processes
• Knowledge of insurance eligibility, authorization, and benefits verification processes
• Proficiency with Microsoft Office (Outlook, Word, and Excel)

Preferred Qualifications:

• Experience working in a hospital, physician practice, or healthcare revenue cycle environment
• Experience using Epic, Cerner, Meditech, or other healthcare information systems
• Experience utilizing payer portals and authorization systems
• Knowledge of medical terminology and coding
• Previous remote healthcare experience

Employment eligibility: 

• Candidates must be legally authorized to work in the United States at the time of hire
• The company does not provide employment visa sponsorship for this position
• As a condition of employment, a pre-employment background check will be conducted
• Certain positions may also require pre-employment drug testing
• At this time, we are unable to consider candidates residing in the state of New York for this position 

What We Offer: 

✓ Comprehensive Paid Training
✓ Medical, Dental & Vision Insurance
✓ HSA & FSA Available
✓ 401(k) with Company Match
✓ Paid Wellness Time & Holidays
✓ Employer-Paid Life Insurance & Long-Term Disability
✓ Internal Growth Opportunities

Meduit is an Equal Opportunity Employer. We do not discriminate based on any protected class and welcome applicants from all backgrounds, consistent with applicable laws. Employment is contingent upon successful completion of a background check, satisfactory references, and any required documentation. 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. 

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