Medical Assistant
6 days ago
Blue Health is seeking a Prior Authorization Specialist (also known as Clinical Authorization Coordinator) with a medical or allied health science background for a non-clinical role supporting our prior authorization process.
(Students are encouraged to apply)
This position combines healthcare expertise with cutting-edge technology and offers a dynamic, innovation-driven environment modeled on US healthcare standards.
Key responsibilities:
- Review prior authorization requests for medical services, procedures, and prescriptions.
- Apply clinical knowledge and payer guidelines to assess medical necessity.
- Ensure compliance with HIPAA and payer-specific requirements.
- Coordinate with physicians, pharmacists, and healthcare providers to obtain supporting documentation.
- Maintain accurate case records in EHR/EMR systems.
- Support appeals and denials management when required.
- Leverage AI-based tools to streamline authorization workflows and improve decision-making efficiency.
Requirements:
- Background in Nursing, Pharmacy, or Allied Health Sciences (RN, LPN, BSN, PharmD, CPhT, or equivalent).
- Strong understanding of medical terminology and payer guidelines.
- Prior experience in utilization management, authorization, or clinical review is highly preferred.
- Excellent communication, organizational, and analytical skills with attention to detail.
Qualifications:
- Bachelor's degree in Nursing, Pharmacy, Allied Health, or equivalent clinical field.
- Preferred: MBBS, DPT, or PharmD.
- Ability to work independently in a fast-paced, tech-enabled environment.
- Familiarity with EHR/EMR systems and insurance workflows.
Why Blue health:
- Exposure to cutting-edge AI tools that enhance efficiency, learning, and communication.
- At Blue Health, your accent naturally improves through regular communication practice, supporting success in international healthcare language exams.
- Professional connections and internship opportunities in the US healthcare system.
- A culture that rewards innovation, encourages creative development, and recognizes individual contribution.
- No-boss culture work in a flat, collaborative structure focused on mentorship and growth.
- Experience a US-style work environment blending healthcare operations and continuous learning.
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