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Remote Prior Authorization Jobs in Florida (NOW HIRING)

TEKsystems

Remote Insurance Verification

Orlando, FL · Remote

$20/hr

Processing, monitoring, and managing prior authorizations and appeals to help patients initiate or continue therapy without interruption. * Communicating with patients, healthcare providers ...

Ennoble Care

Care Coordinator

Orlando, FL · Remote

$75K - $85K/yr

Serve as first point of escalation for CC team questions on referrals, prior authorizations, DME ... Remote position based in Central Florida (Orlando metro area preferred) * Must be available during ...

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Remote Prior Authorization information

What are remote prior authorization jobs?

Remote prior authorization jobs involve reviewing and processing requests from healthcare providers to determine if specific medical treatments, medications, or procedures are covered by a patient's insurance plan. Employees in these roles work from home, utilizing online systems to evaluate clinical information, communicate with providers, and ensure compliance with insurance policies. This position requires a strong understanding of medical terminology, insurance guidelines, and attention to detail to facilitate timely and accurate approvals or denials. Remote prior authorization specialists help streamline patient care by acting as a liaison between healthcare providers and insurance companies.

What are some common challenges faced by Remote Prior Authorization specialists, and how can they be addressed?

Remote Prior Authorization specialists often encounter challenges such as navigating complex insurance requirements, managing high volumes of requests, and maintaining clear communication with healthcare providers and payers. Staying organized and up-to-date on payer policies is crucial, as requirements can vary widely between insurers. Utilizing workflow management tools and fostering strong collaboration with clinical and administrative teams can help streamline processes and reduce delays, ultimately ensuring patients receive timely care.

What are the key skills and qualifications needed to thrive as a Remote Prior Authorization Specialist, and why are they important?

To thrive as a Remote Prior Authorization Specialist, you need a solid understanding of medical terminology, insurance processes, and healthcare regulations, often supported by experience in medical billing or coding. Familiarity with electronic health record (EHR) systems, insurance portals, and prior authorization software is typically required. Attention to detail, strong organizational skills, and effective communication are crucial soft skills in this role. These skills ensure timely and accurate processing of authorizations, reducing claim denials and supporting efficient patient care.

What is the difference between Remote Prior Authorization vs Remote Medical Coder?

AspectRemote Prior AuthorizationRemote Medical Coder
Required CredentialsMedical credentials, insurance knowledgeMedical coding certification (CPC, CCS)
Work EnvironmentHealthcare offices, insurance companies, remoteHealthcare facilities, remote coding jobs
Industry UsageInsurance, healthcare providersHospitals, clinics, billing companies
Job FocusReviewing and approving insurance requestsTranslating medical records into codes

Remote Prior Authorization and Remote Medical Coder roles both operate within the healthcare industry but focus on different tasks. Remote Prior Authorization involves reviewing insurance requests for coverage approval, requiring insurance and medical knowledge. Remote Medical Coders translate medical records into standardized codes, primarily focusing on billing and documentation. Both roles can be performed remotely and require healthcare-related credentials, but their daily responsibilities and skill sets differ significantly.

What Are Remote Prior Authorization Jobs?

Remote prior authorization jobs focus on working with insurance companies to coordinate benefit coverage and get approval to provide care for a patient. In this pre-authorization role, you may collect documentation and proof of insurance, perform data entry, help evaluate the need for a particular process, and otherwise work from home to help manage the prior authorization process. Remote prior authorization personnel often answer telephone calls to provide consultations, perform initial benefit verification, document case status, actions, and outcomes in a database, and use customer service skills to help expedite cases as needed. Since this is a remote call center-style job, you may be asked to arrange for a quiet office in your house that is free of distractions.

More about Remote Prior Authorization jobs
What are the most commonly searched types of Prior Authorization jobs in Florida? The most popular types of Prior Authorization jobs in Florida are:
What are popular job titles related to Remote Prior Authorization jobs in Florida? For Remote Prior Authorization jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization jobs in Florida look for? The top searched job categories for Remote Prior Authorization jobs in Florida are:
What cities in Florida are hiring for Remote Prior Authorization jobs? Cities in Florida with the most Remote Prior Authorization job openings:
Remote Prior Authorization jobs near you
Oncology Prior Authorization Case Manager, Non-RN - Remote

Oncology Prior Authorization Case Manager, Non-RN - Remote

University of Miami

Miami, FL • On-site, Remote

Full-time

Medical, Dental

Re-posted 3 days ago

University Of Miami rating

7.7

Company rating: 7.7 out of 10

Based on 52 frontline employees who took The Breakroom Quiz

228th of 555 rated colleges and universities

Job description

Current Employees:

If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet.

The University of Miami Health System Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for optimal and efficient patient outcomes, while avoiding treatment delays and authorization denials. They are accountable for a designated patient caseload and provide intervention and coordination to decrease avoidable delays, at all times they provide communication of progress and or determination to the clinical team and or the patient. He/she monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. Evaluates the needs of the patient, the resources available, and recommends and facilitates for the best outcome to meet ongoing patient needs that encourages compliance with medical advice.

CORE FUNCTIONS:

  • Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of care services

  • Follows the authorization process using established criteria as set forth by the payer or clinical guidelines

  • Accurate review of coverage benefits and payer policy limitations to determine appropriateness of requested services

  • Refers to the treatment plan for clinical reviews in accordance with established criteria and guidelines

  • Facilitates communication of denials and or Peer to Peer requests between payers and the healthcare team

  • Identifies potential delays in treatment or inappropriate utilization by reviewing the treatment plan, serves as a resource to provide education regarding payer policies and assists with coordination of alternative treatment options

  • Ensures and Maintains effective communication regarding authorization status and determination to the clinical team and on occasion the patient.

  • Proactive communication with leadership regarding barriers and or potential delays in care Identifies opportunities for expedited requests and prioritizes caseload accordingly

  • Maintains knowledge regarding payer reimbursement policies and clinical guidelines.

  • This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS:

Education:

Bachelor's degree in relevant field; or equivalent

Experience:

Minimum of 2 years of relevant experience

Oncology - Preferred

Any relevant education, certifications and/or work experience may be considered

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status:

Full time

Employee Type:

Staff

What University Of Miami employees say

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About University of Miami

Sourced by ZipRecruiter

The University of Miami, located in the beautiful Coral Gables, Florida, is a comprehensive, private research institution in the United States. Operating within the higher education industry, the institution offers a multitude of degree programs spanning over 180 majors and program through its 12 colleges. The University was founded in 1925 with the mission to disseminate knowledge, transform lives, and change the world - a mission it has held faithfully to this day. Notably, the University of Miami has gained global recognition for its commitment to research and innovation, with over $324 million in research and sponsored project funding awarded annually.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Coral Gables, FL, US

Year founded

1925

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