Remote Retina/Ophthalmology Prior Authorization Specialist

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

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.