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Work From Home Prior Authorization Jobs in Puerto Rico

OncoHealth

Case Review Representative

Guaynabo, PR · On-site +1

$13 - $15/hr

Prior authorization creation * Quality Performance Program Outreach when assigned * Triage and ... can work remotely from home the rest of the days. Employees are welcome to work from the office ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

... can work remotely from home the rest of the days. Employees are welcome to work from the office ... Prior Authorization portal for all oncology drug request and treatments. Our system improves ...

InsuraTec

Sales Representative (Remote)

Mayaguez, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Guaynabo, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

San Juan, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Dorado, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Canovanas, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Hormigueros, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Arecibo, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Vega Baja, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Fajardo, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Ponce, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Juana Diaz, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Bayamon, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Isabela, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Catano, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

InsuraTec

Sales Representative (Remote)

Rio Grande, PR · Remote

Enjoy the freedom to work from home on your schedule. * Work-Life Balance : Achieve balance with our flexible hours. Qualifications: * Entry-Level Friendly : No prior experience needed; we offer full ...

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All JobsPrior Authorization JobsWork From Home Prior Authorization JobsWork From Home Prior Authorization Jobs in Puerto Rico

Work From Home Prior Authorization information

What is a work from home prior authorization specialist?

A Work From Home Prior Authorization specialist is a professional who reviews and processes prior authorization requests for medical procedures, medications, or services from a remote location. They work with healthcare providers, insurance companies, and patients to ensure that necessary approvals are obtained before services are rendered. Their responsibilities include evaluating documentation, verifying insurance coverage, and communicating decisions, all while adhering to privacy regulations and company protocols. This role requires strong attention to detail, excellent communication skills, and proficiency with healthcare management software.

What are work from home prior authorization jobs?

As a work from home prior authorization specialist, you obtain prior authorization approval from insurance companies on behalf of health care providers. Your responsibilities include verifying patient insurance coverage and benefits as written in their policy, confirming procedure coverage, and working virtually with a team to accomplish prescribed tasks. Other duties include identifying patient information and updating records to prevent billing issues. Because you perform telephonic reviews, you can work from home in the right circumstances. You can also work as a remote medical biller, registered nurse, or pharmacy technician.

What are the key skills and qualifications needed to thrive as a work from home prior authorization specialist?

To thrive as a Work From Home Prior Authorization Specialist, you need a background in healthcare administration or insurance, familiarity with medical terminology, and often a relevant certification or experience in prior authorizations. Proficiency with healthcare management software, electronic health records (EHR), and payer portals is typically required. Attention to detail, strong communication skills, and the ability to work independently are standout soft skills for this role. These abilities ensure timely and accurate processing of authorizations, which is crucial for patient care and efficient healthcare operations.

What are some common challenges faced by work from home prior authorization specialists, and how can they overcome them?

Work from home prior authorization specialists often face challenges related to remote communication, such as staying connected with healthcare providers and insurance representatives. They may also encounter difficulties in accessing confidential patient information securely and managing high volumes of authorization requests within tight deadlines. To overcome these challenges, it's important to maintain strong organizational skills, leverage secure digital platforms for communication and document management, and participate in regular team check-ins to stay aligned with workflow updates. Proactively seeking clarification on complex cases and staying up-to-date with payer guidelines can also help ensure accuracy and efficiency.

What is the difference between Work From Home Prior Authorization vs Work From Home Medical Coder?

AspectWork From Home Prior AuthorizationWork From Home Medical Coder
Required CredentialsTypically requires healthcare administration or insurance knowledge, certifications like NCQA or AHIPRequires coding certifications such as CPC, CCS, or CCS-P
Work EnvironmentRemote, often in healthcare or insurance companiesRemote, in healthcare facilities or coding companies
Employer & Industry UsageInsurance companies, healthcare providersHospitals, clinics, medical billing companies
Common Search & ComparisonYesYes

Work From Home Prior Authorization involves obtaining approval for medical services remotely, focusing on insurance and healthcare administration. Work From Home Medical Coder involves translating medical records into codes for billing, also performed remotely. Both roles require healthcare knowledge but differ in certifications and daily tasks.

What career paths follow work from home prior authorization?

Work from home prior authorization roles typically lead to careers in healthcare administration, medical billing, coding, or insurance claims processing. These positions often require knowledge of healthcare policies, attention to detail, and proficiency with electronic health record systems, providing opportunities for advancement into management or specialized compliance roles.
More about Work From Home Prior Authorization jobs

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For Work From Home Prior Authorization jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Work From Home Prior Authorization jobs in Puerto Rico look for?

The top searched job categories for Work From Home Prior Authorization jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Work From Home Prior Authorization jobs?

Cities in Puerto Rico with the most Work From Home Prior Authorization job openings:

Work From Home Prior Authorization jobs near you
Infographic showing various Work From Home Prior Authorization job openings in Puerto Rico as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution.

Case Review Representative

OncoHealth

Guaynabo, PR • On-site, Remote

$13 - $15/hr

Full-time

Re-posted 10 days ago

Job description

About OncoHealth
OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.
About the Role
The Case Review Representative serves as a one-stop shop and intake of all calls (members and providers). Resolves tier one issues (user resets, provider data management, fax and letter receipt, general questions).
Primary Responsibilities
  • Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 5:00 pm EST (Office hours may change/extend upon operational needs)
  • Fax intake and labeling
  • Prior authorization creation
  • Quality Performance Program Outreach when assigned
  • Triage and manage inbound calls, routing case specific calls to an appropriate team member, and resolving tier 1 level issues
  • Triage and manage inbound emails from health plan clients, routing case specific emails to an appropriate team member, and resolving tier 1 level issues
  • Triage request/claims processing issues to health plans as needed Prior authorization creation
  • Quality Performance Program Outreach when assigned
About You
  • College degree or relevant experience preferred
  • Fully Bilingual (English and Spanish)
  • Remote/hybrid work experience preferred
  • A minimum of 2 years of healthcare related administrative experience and/or customer service or relevant educational attainment required
  • Skills for implementation of systems for program effectiveness and productivity required
  • Systems/Tools: MS Office Suite proficient
About the Location
OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.

Our Culture

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!

We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners amp; McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!

Our Current Solutions

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.

OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.

OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

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