Job Overview

Our client is seeking a detail-oriented and highly organized Prior Authorization & Medical Records Specialist to manage administrative functions supporting high-quality patient care. This fully remote position focuses on pharmacy prior authorizations, medical documentation, referrals, medical records, patient scheduling, and electronic health record (EHR) documentation. The ideal candidate will manage multiple priorities, meet strict deadlines, navigate complex insurance requirements, and work independently with minimal supervision.

Schedule

Monday - Friday, 8:00 AM - 5:00 PM PST, with 1 hour unpaid break (40 work hours per week)

Responsibilities

• Pharmacy Prior Authorizations: Process pharmacy prior authorizations for prescription medications in a timely and accurate manner; submit supporting clinical documentation to insurance companies; follow up on pending authorizations, denials, appeals, and renewals; communicate authorization status with providers, pharmacies, insurance representatives, and patients; maintain complete documentation within the EHR.
• Medical Documentation: Complete FMLA, disability, return-to-work, and other leave-related paperwork accurately within required deadlines; prepare physician forms, medical necessity documentation, and additional patient paperwork ensuring compliance with payer requirements and HIPAA regulations.
• Referrals & Medical Records: Process and fax referrals to specialists and ancillary providers; send medical records, laboratory results, imaging reports, and requested health information; track referral completion and respond to requests promptly.
• Patient Care Coordination: Schedule follow-up appointments as directed by providers; communicate with patients regarding referrals, authorizations, documentation, and follow-up care; document all patient interactions accurately within the EHR.
• Administrative Support: Maintain accurate patient records and complete back-office documentation duties in a timely manner; respond promptly to provider requests and internal communications to support efficient clinic operations.

Requirements

• Minimum of three (3) years of recent experience processing pharmacy prior authorizations.
• Excellent working knowledge of medical terminology, insurance plans, pharmacy benefit management (PBM) processes, and medical prior authorization requirements.
• Experience completing FMLA, disability, and other medical leave documentation.
• Hands-on experience working within an Electronic Health Record (EHR/EMR) system.
• Strong computer proficiency, including Microsoft Office Suite and web-based insurance portals.
• Excellent written and verbal communication skills with the ability to communicate professionally across patients, providers, pharmacies, and insurance representatives.
• Capability to work independently in a fully remote environment while maintaining productivity, responsiveness, and complete HIPAA confidentiality.

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations

Note

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

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