-
-
TYPE OF WORK
Full Time
-
-
SALARY
25000 PHP
-
-
HOURS PER WEEK
40
-
-
DATE UPDATED
Mar 25, 2026
About NY Arthritis Clinic
NY Arthritis Clinic is a leading rheumatology and musculoskeletal care practice committed to delivering exceptional, patient-centered treatment to individuals living with arthritis and related conditions. Our team is dedicated to removing barriers to care — and we need a highly experienced authorization specialist to help make that happen.
Position Overview
We are seeking a seasoned Eligibility & Prior Authorization Specialist to join our remote team. In this critical role, you will manage the full prior authorization lifecycle for both medications and procedures, verify patient insurance eligibility, and serve as a key point of contact for patients, providers, and insurance carriers. Strong phone communication skills are essential — this role requires consistent, professional, and high-volume phone interaction on a daily basis.
Key Responsibilities
- Initiate, track, and follow up on prior authorization requests for specialty medications (including biologics, DMARDs, and infusion therapies) and clinical procedures
- Verify patient insurance eligibility and benefits prior to appointments and treatments
- Communicate directly with insurance carriers, pharmacy benefit managers (PBMs), and specialty pharmacies to obtain timely approvals
- Answer inbound calls from patients and providers professionally and efficiently — **phone coverage is a core and non-negotiable function of this role**
- Make outbound calls to insurance companies and pharmacies to expedite authorizations and resolve denials
- Manage and document all authorization activity accurately within the EHR/practice management system
- Coordinate peer-to-peer review requests between physicians and insurance medical directors
- Identify and escalate urgent or time-sensitive authorization needs to the appropriate clinical staff
- Support the appeals process for denied authorizations, including gathering clinical documentation and drafting appeal letters
- Stay current on payer-specific requirements, formulary changes, and CMS guidelines
Requirements & Qualifications
- Minimum **5 years of experience** in prior authorization, insurance verification, or medical billing — specialty or rheumatology experience strongly preferred
- In-depth knowledge of Medicare, Medicaid, and commercial insurance authorization processes
- Experience with specialty medications including biologics (e.g., Humira, Enbrel, Rinvoq, Xeljanz) and infusion therapies highly desirable
- Familiarity with ICD-10, CPT, and HCPCS coding as they relate to authorization requirements
- Proficiency with EHR systems (experience with athenahealth, Epic, or Modernizing Medicine a plus)
- Exceptional phone etiquette and verbal communication skills — comfortable managing high call volumes with professionalism and patience
- Strong written communication skills for appeal letters and payer correspondence
- Highly detail-oriented with the ability to manage multiple open authorizations simultaneously
- Self-directed and able to work independently in a fully remote environment
- Reliable high-speed internet and a quiet, dedicated home workspace required
NY Arthritis Clinic is an equal opportunity employer. We are committed to fostering a diverse and inclusive workplace where all tea
