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Prior Authorization Specialist
Job description:
Prior Authorization Specialist (Prescription Navigator)
Remote | Offshore | Full-Time | (EST Hours)
Compensation: $800– $1000 per month
Employment Type: Direct Hire | Full-Time
About Us
Squad Health provides navigation services and software to US medical practices to remove barriers to treatment — especially prescription access.
Our services include benefits investigation, prior authorization submission, patient assistance enrollment, pharmacy coordination, and patient engagement.
Our team members operate as extensions of provider offices, supporting clinical staff through accurate documentation and consistent follow-up.
Job Summary
We are seeking an experienced Prior Authorization Specialist with strong background in US specialty medication authorizations. This role requires reviewing clinical documentation, verifying insurance benefits, submitting medication authorizations, and managing denials and appeals efficiently.
Duties
- Verify insurance benefits for drug and procedure orders (Commercial, Medicare, Medicaid)
- Determine pharmacy vs. medical benefit requirements when applicable
- Obtain appropriate authorizations by completing payer-specific forms and clinical questionnaires
- Review medical notes, diagnosis information, and treatment history to answer clinical questions accurately
- Submit and manage authorizations through, payer portals, fax, or phone
- Track pending authorizations and follow up until resolution
- Prioritize and manage STAT/urgent requests appropriately
- Communicate with MDs and NPs regarding denials, treatment plan updates, and Letters of Medical Necessity (LMNs)
- Assist patients with copay assistance or patient assistance programs when needed
- Enroll patients into navigation programs and obtain consent
- Document all actions clearly in internal systems and case trackers
- Participate in team meetings to resolve patient access challenges and improve workflow
Required Skills & Experience
- Minimum 2 years of US-based specialty medication prior authorization experience
- Direct experience supporting GI, Dermatology, Rheumatology, and Allergy medication authorizations required
- Strong understanding of US insurance plans (Commercial, Medicare, Medicaid)
- Experience reviewing EMR/EHR clinical documentation
- Strong attention to detail and structured documentation habits
- Fluent English (written and verbal)
- Ability to work full-time night shift aligned with EST hours
Job Type: Full-time
Work Location: Remote
Job Type: Full-time
Pay: ₹70,000.00 - ₹90,000.00 per month
Application Question(s):
- A summary of your relevant experience in United States-based prior authorizations?
- List 5 medications for which you have frequently completed prior authorizations and can discuss during an interview?
- Have you worked in a hospital or doctor's office completing medication prior authorizations? If so, please elaborate what platforms you have used to submit these
- Why are you looking to leave (or have already left) your previous employer?
Work Location: Remote
