Authorizations Specialist (US Healthcare, EST Hours, Remote)

About the role

ISTA Personnel Solutions is recruiting on behalf of a growing U.S.-based healthcare and wellness company for a fully remote Authorizations Specialist. The specialist manages insurance authorization requests from submission through approval, denial or reauthorization, working with healthcare providers, insurance carriers, billing and pharmacy teams and internal departments to meet payer requirements on time.

Key responsibilities

• Manage insurance authorization requests from submission through approval, denial or reauthorization
• Review patient information and clinical documentation to ensure payer requirements are met
• Monitor authorization statuses, expiration dates and upcoming appointments to spot gaps or delays
• Coordinate Single Case Agreements (SCAs) and give status updates to relevant teams
• Complete online enrolments for compliance programs, patient benefits and payer or treatment requirements
• Handle payer-specific requirements such as TRICARE referrals and authorizations
• Process and monitor pharmacy prior authorizations and medication-related approvals
• Maintain accurate authorization, payer, enrolment and patient data in Salesforce and other systems
• Prepare evaluation and billing documentation, follow up on outstanding requests and denials, and complete required reports
• Assist with developing authorization and payer workflows and supporting system improvements

Required profile

• Experience in healthcare insurance authorizations, medical aid, benefits verification, medical billing, claims or utilization management is preferred
• Experience with medical aids, payer portals or online healthcare enrollment systems is advantageous
• Previous experience supporting a U.S. healthcare client or working with U.S. insurance/payer requirements is advantageous
• Working hours Monday to Friday, 09:00 AM to 18:00 PM EST (15:00 PM to midnight South African time, subject to daylight saving); flexibility on Fridays and working on both South African and U.S. public holidays (SA holidays compensated per the BCEA)

Required skills

• Fixed fibre internet (minimum 25 Mbps upload and download) with wired Ethernet, and reliable power backup
• Strong organization, time management, attention to detail and written and verbal communication
• Ability to manage multiple cases and follow-ups, and to handle confidential patient information
• Salesforce experience is a plus