Eligibility, Benefits, Prior Authorization Specialist

Autism Diagnosis Group

Eligibility, Benefits, & Prior Authorization Specialist in virtual-first healthcare company Josi Health. Verifying insurance coverage and researching telehealth benefit policies with a mission-driven team.

Posted 7/20/2026full-timeRemote • 🌎 Anywhere in the WorldJuniorMid-Level💰 $600 - $800 per monthWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in insurance verification and prior authorizations, with a strong ability to navigate payer policies and communicate effectively with clinical teams and patients. Proficient in medical terminology, CPT, ICD-10, and telehealth billing practices.

Highest-signal resume keywords

Insurance VerificationPrior AuthorizationsCPT and ICD-10 KnowledgePayer Portal NavigationExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance VerificationPrior Authorization ProcessingCPT CodingICD-10 CodingTelehealth Billing ModifiersResearch CapabilitiesPolicy Manual NavigationData ValidationClaim SubmissionDocumentation Management

Soft Skills

Empathetic CommunicationProblem-SolvingCollaborationAttention to DetailDe-escalation Skills

Tools & Technologies

AvailityWaystarEMR SystemsPayer Portals

Industry Keywords

HealthcareInsurance CoverageCommercial PlansVirtual CareRemote Developmental PediatricsPsychological EvaluationsPatient Insurance Benefit LettersRegulatory Requirements

About the role

Key responsibilities & impact

Verify active patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across commercial plans
Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.)
Navigate payor websites, newsletters, and provider manuals to track and document shifting policy guidelines and billing modifiers across 40+ states
Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD-10 data are flawless
Initiate, track, and validate prior authorizations through clearinghouses (e.g., Availity, Waystar), insurance portals, and phone escalations
Ensure all authorizations are secured, confirmed accurate, and fully documented in the EMR before the close of business each day for upcoming clinics
Act as the go-to resource for clinical teams when a payer's prior-authorization process is vague, contradictory, or unmapped
Validate conflicting information from multiple insurance sources to determine the most credible, risk-free path for claim submission
Build, update, and maintain internal state-by-state reference guides on commercial insurance and state-by-state regulatory requirements
Prepare clear, professional patient insurance benefit letters outlining estimated out-of-pocket costs and referral requirements
Collaborate closely with clinic coordinators and clinical staff to resolve last-minute scheduling exceptions or authorization gaps
Help de-escalate patient or provider concerns regarding coverage limits with professional, empathetic communication

Requirements

What you’ll need

2+ years of healthcare clinic or startup experience specializing in insurance verification and prior authorizations
Strong research capabilities: deep comfort navigating payor portals, digging through policy manuals, and calling payor representatives to clarify ambiguous rules
Hands-on experience working with multiple major commercial payers (e.g., BCBS, Optum, Aetna)
Working knowledge of medical terminology, CPT, ICD-10, and telehealth billing modifiers
Excellent written and verbal English communication skills: ability to translate technical insurance terms into simple, clear explanations
High-speed internet, backup power setup, and the ability to work full-time during EST business hours