Prior Authorization, Benefits & Medical Records Specialist - eCW

We are a physician-led interventional pain management clinic in the U.S. Midwest seeking one experienced Prior Authorization, Benefits, and Medical Records Specialist. This is a hands-on provider-side role for an organized person who can independently own several queues, document every action, and close tasks instead of merely passing messages.

SCHEDULE AND PAY
- Full time, 40 hours per week
- Monday-Friday, 8:00 AM-5:00 PM U.S. Central Time, with a one-hour unpaid meal break
- $6-$8 USD per hour, based on verified experience
- This is an overnight shift in the Philippines and requires dependable long-term availability

REQUIRED EXPERIENCE
- At least 2-3 years of U.S. provider-side medical-office experience
- Hands-on eClinicalWorks experience; this is not a training-from-zero position
- End-to-end prior authorization and benefits-verification experience
- Experience with payer portals, insurance calls, fax follow-up, reference numbers, deadlines, and status tracking
- Ability to match CPT/HCPCS, ICD-10, provider, site of service, dates, units, laterality, payer, authorization, and supporting clinical records
- Understanding of pain-clinic or comparable outpatient procedure workflows
- Experience requesting, organizing, uploading, routing, and tracking medical records and incoming faxes
- Strong organization, written English, independent problem-solving, documentation, and escalation judgment
- Reliable computer, private workspace, stable primary internet, backup internet, backup power, headset, and webcam
- HIPAA-safe handling of patient information

PRIMARY RESPONSIBILITIES
- Verify eligibility, active coverage, effective dates, deductible, coinsurance, copay, network status, benefits, and authorization requirements
- Submit and follow prior authorizations for procedures, imaging, and medications
- Track pending, approved, denied, expired, and incomplete requests in eClinicalWorks and payer portals
- Confirm that authorization details match the intended code, diagnosis, provider, facility/site, date range, units, and laterality
- Obtain and organize clinical documentation needed for medical necessity
- Record portal confirmation numbers, payer-call reference numbers, deadlines, status, and next action
- Prepare reconsideration, peer-to-peer, or appeal materials under clinic direction
- Request, receive, identify, upload, route, and follow medical records and faxes
- Back up referral, records, front-office, and other medical-office queues when needed
- Maintain a daily aging and unresolved-task report

Common services may include epidural steroid injections, medial branch blocks, radiofrequency ablation, sacroiliac-joint injections, joint injections, trigger-point injections, imaging, medications, and related pain services. You do not make medical decisions or promise that a payer will approve or pay a service.

DIRECT INDIVIDUAL HIRE AND DEDICATED SHIFT
We hire only the individual who applies and personally performs the work. We will not hire through an agency, BPO placement firm, staffing company, outsourcing firm, subcontracting team, or substitute-worker arrangement.

Outside work must be disclosed and must not overlap or interfere with this position. During our paid 8:00 AM-5:00 PM Central Time shift, you may not:
- Work for or monitor another employer, client, or agency
- Keep another client's work computer or messages active
- Attend another client's calls or meetings
- Run another time tracker
- Delegate or subcontract work
- Share logins or allow another person to cover tasks
- Use mouse jigglers, fake activity, or time padding

Time Doctor or similar time tracking, screenshots, screen sharing, and daily output reports may be required.

CONFIDENTIALITY
Do not save patient information to personal devices or accounts. Do not upload patient information to personal email, cloud storage, messaging apps, ChatGPT, Claude, Gemini, or another outside AI service without written authorization. Do not record calls, take unapproved screenshots, share credentials, or submit PHI in an application or work sample.

HOW TO APPLY
The first line of your application must be:
PA AUTH - ECW - MIDWEST

Include your current resume and answer every question with specific examples:

1. Identify your provider-side U.S. medical-office employers, dates, specialties, and exact duties.
2. Which employer used eClinicalWorks, for how long, and what did you personally do in it?
3. Walk through one procedure authorization from order to final decision, including codes, diagnosis, provider/site/date alignment, clinical records, portal/phone/fax work, reference numbers, and follow-up.
4. Explain how you verify eligibility, effective dates, deductible, coinsurance, copay, network status, benefits, and authorization requirements.
5. Describe one denied or incomplete authorization and how you resolved or escalated it.
6. Explain how you manage incoming faxes, records, referrals, and aging tasks so nothing is lost.
7. Name pain, spine, orthopedic, or other outpatient procedures you have personally authorized.
8. List every current employer, client, agency, or freelance project, exact hours, and whether any work overlaps this shift.
9. Confirm the Central Time schedule, requested rate, internet speeds, backup internet and power, private workspace, and willingness to use time tracking.

Merely listing eClinicalWorks or prior authorization will not receive full skill credit. Incomplete or generic applications may not be reviewed.