Our client is a busy dermatology practice serving over 100 patients per week. The practice is looking for a reliable and detail-oriented Bilingual Prior Authorization & Insurance Verification Specialist to support insurance eligibility verification, prior authorizations, insurance-related phone calls, documentation, and overflow patient call support.
This is not solely a backend insurance role. The VA must be confident in communicating by phone with insurance representatives and patients while accurately documenting information, tracking unresolved items, and following through on authorization requirements.
The ideal candidate has strong experience with U.S. healthcare insurance verification, prior authorization management, phone support, documentation, and task follow-up. Spanish-speaking ability is required.
Scope of Work / Responsibilities
Insurance Eligibility & Benefits Verification
Verify patient insurance eligibility, active coverage, and benefits accurately.
Confirm effective dates, plan type, network status, copays, deductibles, coinsurance, out-of-pocket information, referral requirements, and authorization requirements.
Document all eligibility and benefit information clearly in EZ Derm and/or the practice’s designated workflow.
Ensure insurance details are accessible to the appropriate practice staff.
Insurance Calls & Documentation
Communicate directly with insurance companies regarding eligibility, benefits, authorization requirements, and pending requests.
Document every insurance call completely, including representative name, call reference number, date and time, phone number called, information obtained, and required next action.
Maintain accurate records of insurance calls, eligibility results, authorization updates, pending items, and required follow-ups.
Prior Authorization Management
Manage prior authorizations from submission through final resolution.
Submit prior authorization requests with complete supporting documentation.
Track status updates, additional information requests, approvals, denials, authorization numbers, approved codes, approved units, and authorization date ranges.
Manage submission and tracking of prior authorizations for biologic medications.
Communicate authorization outcomes and next steps to the appropriate practice staff.
Task Follow-Up & Escalation
Create and maintain follow-up tasks for any insurance or authorization item that cannot be completed immediately.
Ensure each pending item has a clear next action and appropriate follow-up date.
Track outstanding items until they are completed, resolved, or escalated.
Escalate clinical, financial, missing information, denial, delay, or decision-making concerns to the Office Manager, Front Office Team, Medical Assistant, or Provider as appropriate.
Phone Support & Patient Communication
Handle insurance-related phone calls as the primary focus of the role.
Provide overflow patient call support as operational needs allow.
Prioritize insurance and authorization responsibilities so general patient call volume does not delay timely follow-up.
Daily Reporting & Administrative Boundaries
Provide a daily End of Day report summarizing completed work and outstanding items.
Include eligibility verifications completed, authorizations submitted, pending authorizations followed up on, approvals and denials received, unresolved items, and matters requiring staff action.
Relay approved administrative information only and maintain appropriate clinical and financial boundaries.
Maintain patient confidentiality and comply with HIPAA and practice policies at all times.
Tools You’ll Use
EZ Derm
3CX phone system
Insurance portals and payer systems
Practice task and documentation workflows
Phone, email, and internal communication systems
Requirements
Experience Requirements
Healthcare Administrative Experience: Required . Candidates must have prior experience in a healthcare or medical practice setting, preferably in insurance verification, prior authorization, medical administrative support, or dermatology.
Bilingual English and Spanish Communication: Required. Candidates must be fluent in both English and Spanish and able to confidently handle full patient and insurance conversations in either language.
Insurance Eligibility & Benefits Verification Experience: Required. Candidates must have hands-on experience verifying active coverage, effective dates, plan type, network status, copays, deductibles, coinsurance, out-of-pocket information, referral requirements, authorization requirements, and applicable benefits.
Prior Authorization Experience: Required. Candidates must have experience managing prior authorizations from submission through resolution, including documentation submission, status follow-ups, additional information requests, approvals, denials, and authorization details.
Biologic Medication Prior Authorization Experience: Strongly preferred. Experience with biologic medication prior authorizations and tracking is highly valuable, especially in dermatology or a similar specialty.
Insurance Phone Communication Experience: Required . Candidates must be comfortable speaking directly with insurance representatives by phone and obtaining complete, accurate information.
Documentation & Task Management Experience: Required. Candidates must be able to maintain detailed records, create follow-up tasks, track pending authorizations, and follow unresolved items through completion.
EZ Derm Experience: Preferred but not required. Candidates must be comfortable learning and working within EZ Derm. Training can be provided.
3CX or Phone System Experience: Preferred but not required. Familiarity with 3CX or similar business phone systems is a plus.
Basic Requirements
Must speak and write English clearly and professionally.
Must have relevant work experience.
Must be able to provide an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
Must be available to attend video meetings with camera on when required.
Technical Requirements
Computer: Reliable laptop or desktop computer.
Internet: Stable high-speed internet connection (minimum 25 Mbps).
Audio: Noise-canceling headset.
Video: Working webcam for virtual meetings.
Workspace: Quiet and professional work environment.
Benefits
Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.
These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.