Remote Prior Authorization Jobs in Stockbridge, GA

CASE MANAGER – REIMBURSEMENT SUPPORT SERVICES

Pay Rate: $20.00 per hour
Work Arrangement: Fully Remote
Schedule: Full-time, 40 hours per week
Business Hours: Monday–Friday, 7:00 AM–7:00 PM CT
Training Schedule: 8:00 AM–5:00 PM CT; mandatory attendance required

JOB OVERVIEW

The Case Manager supports patient access to therapy through Reimbursement Support Services while following program business rules and HIPAA regulations. This position guides healthcare providers through the various steps of the patient journey to therapy, including referral intake, insurance benefit investigations, prior authorization and step therapy reviews, payer follow-up, and coordination with specialty pharmacies and support organizations.

RESPONSIBILITIES

• Manage patient referral intake and support healthcare providers throughout the patient access process.
• Investigate patient health insurance benefits and identify coverage requirements.
• Initiate and follow up on prior authorizations, step therapy reviews, and appeals as applicable.
• Proactively communicate with insurance payers, specialty pharmacies, and support organizations to facilitate timely therapy access and product delivery.
• Resolve complex payer and pharmacy issues while working toward positive outcomes and de-escalating concerns when necessary.
• Conduct both inbound and outbound calls while providing professional and compliant customer support.
• Maintain accurate documentation of patient and insurance-related activities.
• Meet daily task and benefit investigation goals within a high-volume enrollment environment.
• Communicate clearly and effectively through both written and verbal communication.
• Apply established policies, procedures, and company practices to complete standard assignments.
• Consult with supervisors or senior team members when addressing complex or unusual issues.
• Maintain compliance with HIPAA regulations and applicable program requirements.

REQUIRED QUALIFICATIONS

• High school diploma, GED, or equivalent work experience.
• Strong organizational skills and ability to manage multiple tasks efficiently.
• Strong attention to detail and accuracy.
• Excellent written and verbal communication skills.
• Ability to work independently while following established procedures and guidelines.
• Ability to perform effectively in a high-volume environment.
• Ability to handle routine problem resolution and escalate complex issues appropriately.

PREFERRED EXPERIENCE

• 3–6 years of experience in a related field.
• 1–2 years of experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals.
• Previous healthcare experience involving insurance or the pharmaceutical industry.
• Experience with pharmacy benefits management.
• Knowledge of Medicare, Medicaid, and commercially insured payer practices and policies.
• Knowledge of the Health Insurance Marketplace and Affordable Care Act.
• Knowledge of medical/pharmacy billing and coding.
• Previous prior authorization and appeals experience.
• Critical and creative thinking skills.

REMOTE WORK REQUIREMENTS

• Position is fully remote and open to U.S. residents.
• Must have a dedicated, quiet, private, and distraction-free workspace.
• Must have secure, high-speed broadband internet.
• Internet connection must be DSL, cable, or fiber.
• Dial-up, satellite, Wi-Fi, and cellular connections are not acceptable.
• Minimum download speed: 15 Mbps.
• Minimum upload speed: 5 Mbps.
• Maximum ping rate: 30 ms.
• Internet connection must be hardwired directly to the router.
• A surge protector with network line protection is required for company-issued equipment.
• Company will provide the computer, technology, and equipment needed to perform the position.
• Employee is responsible for providing and maintaining the required internet connection.
• Failure to meet remote-work requirements may result in termination of the contract or employment.

TRAINING AND WORK SCHEDULE

New-hire training will be conducted Monday–Friday from 8:00 AM–5:00 PM CT, and attendance is mandatory.

After training, employees must have flexibility to work within the normal business hours of Monday–Friday, 7:00 AM–7:00 PM CT.

This is a full-time position requiring 40 hours per week.

If you are interested, please reach out to Chin Yang at A-Line Staffing.