Prior Authorization Specialist (Multi-Specialty) | Permanent WFH

We are looking for an experienced Prior Authorization Specialist with a strong background in Pulmonology, Gastroenterology, and Internal Medicine. The ideal candidate will be responsible for obtaining timely prior authorizations, verifying insurance coverage, and ensuring accurate documentation to support smooth patient care delivery. Experience with NextGen software is highly preferred.

Key Responsibilities:

• Process and track prior authorization requests for medications, procedures, and treatments.
• Verify patient insurance coverage, eligibility, and benefits.
• Collaborate with physicians, nurses, and insurance providers to obtain necessary approvals.
• Document and update all authorizations and communications in NextGen EMR.
• Identify and resolve prior authorization delays or denials in a timely manner.
• Maintain compliance with HIPAA and payer-specific guidelines.

• Minimum 3 years of experience in prior authorization or medical billing/insurance verification.
• Strong knowledge in Pulmonology, Gastroenterology, and Internal Medicine workflows.
• Proficiency in NextGen software preferred.
• Familiarity with payer requirements and medical terminology.
• Excellent communication, organizational, and problem-solving skills.
• Ability to work independently in a fast-paced environment.
• Amenable to work during U.S. business working hours.

Work-from-Home Device Requirement:

• Device: Personal computer with Intel Core i5 or higher, or AMD Ryzen 5 or higher
• Internet: Wired connection with at least 50 Mbps download speed, plus a backup connection (e.g., mobile hotspot or prepaid Wi-Fi)
• Work Environment: Quiet, well-lit space with minimal background noise

• Permanent Work From Home
• Weekly Paychecks
• Fixed Weekends Off
• HMO Reimbursement on your 90th day
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary

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Who are we?

MedCore Solutions is the healthcare division of BizForce, dedicated to supporting U.S.-based healthcare clients through a skilled remote workforce in the Philippines. We specialize in connecting top clinical and administrative talent with reputable healthcare organizations, ensuring high-quality care delivery while providing rewarding work-from-home careers.

Why work for Bizforce? 

Bizforce is a global remote workforce solutions company currently partnering with some of the largest Architectural and Engineering firms in the world. If you are looking to advance your career and improve your skills with an industry leader, we encourage you to apply today! Bizforce was founded with one goal – to deliver dependable high-quality skilled labor and business processes to US-based companies at affordable prices. Bizforce has grown rapidly and allows the best talent in PH to work remotely from home with the latest technology and resources. BizForce is proud to partner with PH to deliver qualified, professional workers, giving our Architects and Engineers the ability to have an unbeatable career and work from home.