Prior Authorization Specialist – Retina/Ophthalmology | Permanent WFH

BizForce; Metro Manila; Remote; PHP 279,000 - 502,000; Full time

Benefits offered by this job

Permanent Work From Home

Leave Credits

Monetary Allowance

Annual Bonus

Weekly Paychecks

Fixed Weekends Off

Specialized Training Programs

Competitive Salary

Job summary

BizForce is seeking an experienced Prior Authorization Specialist for our retina/ophthalmology practice in a fully remote capacity. The role focuses on managing authorizations, reviewing payer requirements, and coordinating with physicians, billing teams, and patients to ensure timely care.

Ideal candidates will have Nextech EMR experience and strong English communication, with a willingness to work US hours and cross-train in related revenue-cycle functions as needed.

Qualifications

• 3+ years of prior authorization experience in ophthalmology/retina.
• Strong understanding of insurance authorization processes and payer requirements.
• Experience with commercial insurance, Medicare, and other payers.
• Nextech EMR experience strongly preferred.
• Excellent written and verbal English communication.

Responsibilities

• Obtain and manage prior authorizations for ophthalmology and retina procedures, treatments, medications, injections, surgeries, and other specialty services.
• Review insurance benefits and payer requirements to determine when prior authorization is required.
• Submit authorization requests through payer portals, telephone, fax, and other required channels.
• Monitor pending authorizations and proactively follow up to prevent delays in patient care.
• Communicate with insurance companies regarding authorization requirements, clinical documentation, coverage criteria, and status.
• Coordinate with physicians, clinical staff, and billing teams to obtain required documentation.
• Maintain accurate authorization records and document payer communications in the EMR.
• Track authorization deadlines, approvals, denials, and expiration dates.
• Identify denials or missing information and assist with next steps including documentation and possible appeals.
• Communicate with patients regarding authorization-related questions and status updates.
• Ensure HIPAA compliance and protect patient information.
• Work independently while staying aligned with a remote practice team.

Skills

Communication

Organizational skills

Multitasking

Independent work

Team coordination

Tools

Nextech EMR

Job description

We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our busy retina/ophthalmology practice. The ideal candidate will have hands-on experience managing prior authorizations for ophthalmology or retina procedures, treatments, medications, and services, along with a strong understanding of insurance requirements and payer processes.

Nextech EMR experience is highly preferred. The successful candidate will be an excellent communicator who can work effectively with insurance companies, physicians, clinical staff, billing teams, and patients.

This position may also provide opportunities for cross-training in insurance eligibility and benefits verification and outgoing patient accounts receivable (A/R) calls. We are looking for someone who is adaptable, dependable, and willing to support multiple areas of the revenue cycle as practice needs evolve.

Key Responsibilities

• Obtain and manage prior authorizations for ophthalmology and retina procedures, treatments, medications, injections, surgeries, and other specialty services.
• Review insurance benefits and payer requirements to determine when prior authorization is required.
• Submit authorization requests through payer portals, telephone, fax, and other required channels.
• Monitor pending authorizations and proactively follow up to prevent delays in patient care.
• Communicate with insurance companies regarding authorization requirements, clinical documentation, coverage criteria, and authorization status.
• Coordinate with physicians, clinical staff, and billing teams to obtain required clinical documentation and supporting information.
• Maintain accurate authorization records and document all payer communications and actions in the EMR.
• Track authorization deadlines, approvals, denials, and expiration dates.
• Identify authorization denials, missing information, or other issues and assist with appropriate next steps, including additional documentation and appeals when applicable.
• Communicate professionally with patients regarding authorization-related questions, requirements, and status updates.
• Protect patient information and maintain strict compliance with HIPAA and practice policies.
• Work independently while maintaining clear and timely communication with the remote practice team.

Qualifications

• 3+ years of prior authorization experience, preferably in retina, ophthalmology, or another specialty medical practice.
• Strong understanding of insurance authorization processes, payer requirements, and medical necessity criteria.
• Experience working with commercial insurance, Medicare, and other healthcare payers.
• Nextech EMR experience strongly preferred.
• Experience with ophthalmology or retina procedures, intravitreal injections, surgeries, diagnostic testing, or specialty medications is highly preferred.
• Strong computer skills and the ability to efficiently navigate multiple payer portals and healthcare systems.
• Excellent written and verbal English communication skills.
• Strong professional phone presence and confidence communicating with insurance representatives, providers, clinical staff, and patients.
• Exceptional organizational skills and attention to detail.
• Ability to manage multiple authorizations, priorities, and deadlines simultaneously.
• Strong problem-solving and follow-up skills.
• Ability to work independently while remaining responsive and collaborative with a remote team.
• Flexible, dependable, and willing to cross-train in other revenue cycle functions.
• Amenable to work during US hours
• Must be willing to undergo a background check as part of the hiring process.

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary

Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH! Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.