RemoteLeaf Logo
Log in Sign up

Authorizations Specialist | US Healthcare | EST Hours | Remote

1 week, 6 days ago
South Africa
Full-time
Mid Level
Operations Specialist
Operations
Salesforce
Apply Now
ISTA Solutions

ISTA Solutions

ISTA Solutions is a one-stop outsourcing company that provides quality and cost-efficient services and solutions. They offer tailor-made workflow solutions, skilled agents dedicated to clients, global resources for comprehensive support, and a focus on...

Professional Services
251-1K
Founded 2015
View All Jobs 3

Description

  • Manage insurance authorization requests from submission through approval, denial, or reauthorization.
  • Review patient information and clinical documentation for payer and authorization compliance.
  • Monitor authorization statuses, expiration dates, appointments, and potential treatment delays.
  • Coordinate Single Case Agreements, TRICARE referrals, pharmacy prior authorizations, and medication approvals.
  • Complete online enrolments related to compliance programs, patient benefits, payers, and treatment requirements.
  • Maintain accurate authorization, payer, enrolment, and patient records in Salesforce and other systems.
  • Communicate with insurers, healthcare providers, billing and pharmacy partners, and internal teams.
  • Follow up on outstanding requests, missing documentation, denials, enrolments, and other barriers to care.
  • Prepare reports and evaluation or billing-related documentation.
  • Document workflows and support process improvements that increase efficiency and reduce delays.

Requirements

  • Experience in healthcare insurance or medical aid authorizations, benefits verification, medical billing, claims, utilization management, or related healthcare administration is preferred.
  • Experience with medical aids, insurance providers, payer portals, or online healthcare enrolment systems is advantageous.
  • Understanding of insurance benefits, prior authorizations, referrals, claims, and payer requirements.
  • Strong organisational, time-management, communication, problem-solving, and critical-thinking skills.
  • Excellent attention to detail and accuracy when handling multiple cases, deadlines, and follow-ups.
  • Proactive, self-motivated, and able to work independently through task completion.
  • Comfort with technology and learning new systems; Salesforce experience is a plus.
  • Ability to collaborate with clinical, administrative, billing, pharmacy, and internal teams.
  • Ability to maintain confidentiality when handling sensitive patient information.
  • U.S. healthcare client or U.S. insurance and payer experience is advantageous.
  • Availability to work Monday–Friday, 09:00–18:00 EST, including South African and U.S. public holidays.
  • Fixed fibre internet with at least 25 Mbps upload and download speeds, wired Ethernet capability, and reliable power backup are mandatory.

Benefits

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

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

DropZero Digital

Operations Associate (Hiring or Client Delivery)

DropZero Digital 1-10 Media

Drop Zero Digital is hiring an autonomous operations professional to grow its AI image service by owning either recruiting operations or client delivery operations and resolving issues without being managed.

Philippines Full-time Mid Level Operations Specialist
$12k-$12k
5 hours, 15 minutes ago
ARETUM

Procurement Specialist

ARETUM Construction & Engineering

Aretum is seeking a Procurement Specialist to support CISA IT federal acquisition and contract management activities, from requirements development through post-award tracking and reporting.

United States Full-time Mid Level Operations Specialist
$105k-$125k
Power BI
5 hours, 15 minutes ago
Guidant Financial

Retirement Plan Operations Specialist

Guidant Financial 51-250 Diversified Financial Services

Guidant Financial is hiring a fully remote Retirement Plan Operations Specialist to support clients with 401(k) administration, testing, annual reporting, and government filings.

United States Full-time Junior Operations Specialist
$49k-$49k
5 hours, 15 minutes ago
Pavago

Assistant Property Manager

Pavago IT Services

Pavago is hiring a full-time remote Assistant Property Manager to support residential and commercial property operations, tenant services, leasing, maintenance, rent collection, and documentation during U.S. business hours.

Mexico Argentina Brazil Colombia Costa Rica Full-time Junior Operations Specialist
5 hours, 30 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers