Patient Access & Insurance Authorization Specialist

Edge; Pakistan; À distance; PKR 13 847 000 - 19 385 000; Plein temps

Résumé du poste

Edge is seeking a Patient Service Representative to support US-based healthcare providers. You will verify patient eligibility, determine financial responsibilities, and manage prior authorizations while coordinating with patients, clinics, and insurers.

The role requires experience with US insurance concepts and proficiency navigating portals like Availity, Optum, and CoverMyMeds, along with EHR systems such as ECW, Tebra, or Dentrix. Remote work is supported for this global opportunity.

Qualifications

• 1 year or more of direct experience in US Healthcare (scheduling, eligibility, prior authorizations, insurance verification)
• Deep understanding of US insurance concepts (PPO, HMO, EOBs, copays, benefits verification)
• Proficiency navigating insurance portals and EHR/practice management systems

Responsabilités

• Conduct eligibility checking and benefits verification for patients prior to appointments
• Interpret insurance policies and determine patient financial responsibilities
• Prepare and submit prior authorization requests via portals, fax, or phone
• Review clinical documentation to ensure medical necessity criteria are met
• Track status of authorizations, manage appeals for denied claims, expedite urgent requests
• Handle inbound/outbound calls to schedule, reschedule, and remind patients of visits

Connaissances

Verbal English

Attention to detail

Analytical skills

Outils

Availity

Optum

CoverMyMeds

ECW

Tebra

Dentrix

Description du poste

Edge is seeking a Patient Service Representative to support US-based healthcare providers. You will verify patient eligibility, determine financial responsibilities, and manage prior authorizations while coordinating with patients, clinics, and insurers.

The role requires experience with US insurance concepts and proficiency navigating portals like Availity, Optum, and CoverMyMeds, along with EHR systems such as ECW, Tebra, or Dentrix. Remote work is supported for this global opportunity.