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Bilingual Prior Authorization Specialist

3 hours ago
El Salvador, Guatemala, Honduras, Nicaragua, Peru, Colombia
Full-time
Junior
Operations Specialist
Customer and Technical Support
HIPAA
Apply Now
Staffing For Doctors

Staffing For Doctors

Staffing For Doctors provides virtual medical staffing solutions for healthcare practices, connecting them with top HIPAA-compliant candidates to enhance operational efficiency, reduce overhead costs, and improve patient care through dedicated virtual ...

Health Care Providers & Services
Founded 2025
View All Jobs 18

Description

  • Submit and secure prior authorizations for complex procedures, specialty medications, high-level imaging, and specialty referrals.
  • Review clinical charts in ModMed/EMA to ensure medical necessity documentation supports payer requirements before submission.
  • Track authorization pipelines and follow up with insurance medical directors and utilization management teams to avoid treatment delays.
  • Research, write, and submit technical appeals for denied authorizations using provider clinical notes and payer documentation.
  • Perform deep-dive eligibility checks to verify coverage limitations, deductibles, and policy exclusions.
  • Track authorization expiration dates, utilization caps, and renewal cycles to prevent retroactive claim rejections.
  • Manage inbound and outbound calls with patients and insurance providers through the Optum phone system in a professional, empathetic manner.
  • Partner with clinicians and providers to obtain clinical notes, peer-to-peer review scheduling data, and updated CPT/ICD-10 codes.
  • Document authorization confirmation numbers, approved services, and payer correspondence in the patient’s EMR record.

Requirements

  • Minimum 2+ years of dedicated prior authorization and insurance appeals experience in a U.S. medical practice.
  • High-level bilingual fluency in English and Spanish.
  • Clear, highly articulate English verbal communication with little to no accent.
  • Solid working knowledge of CPT codes, ICD-10 codes, and medical necessity documentation rules.
  • Agreement to work under a mandatory automated time-tracker.
  • Ability to maintain a quiet, highly secure home office that complies with HIPAA regulations.
  • Direct, daily operational familiarity with ModMed (Modernizing Medicine) / EMA EHR is strongly preferred.
  • Prior experience managing communication queues through the Optum VoIP phone system is strongly preferred.
  • Specialized background reviewing clinical charts for surgical specialties or advanced diagnostic imaging authorizations is strongly preferred.

Interested in this position?

Apply directly on the company website

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