Prior Authorization Specialist

Pay: 70,000.00 - 105,000.00 per month

Prior Authorization Specialist (Prescription Navigator)

Remote | Offshore | Full-Time | EST Hours

Three options of working off-hours to choose from:

Weekdays | Work Hours 3:30 AM 12:30 PM India Time (6:00 PM 3:00 AM EST)

Weekdays | Work Hours 9:30 AM 6:30 PM India Time (12:00 AM 9:00 AM EST)

Weekends | Work Hours: 6:30 PM – 2:30 AM India Time (9:00 AM – 5:00 PM EST)

Employment Type: Direct Hire | Full-Time

About Us

Squad Health provides navigation services and software to US medical practices to remove barriers to treatment — especially prescription access.

Our services include benefits investigation, prior authorization submission, patient assistance enrollment, pharmacy coordination, and patient engagement.

Our team members operate as extensions of provider offices, supporting clinical staff through accurate documentation and consistent follow-up.

Job Summary

MPORTANT: DO NOT APPLY IF YOU DO NOT MEET THIS REQUIREMENT

This position requires 2–3 years of direct, hands-on experience as a Prescription Medication Prior Authorization Specialist supporting United States healthcare providers and patients.

Applicants without recent, direct experience completing medication prior authorizations, benefits investigations, payer communications, denials, appeals, and specialty medication access workflows for US-based practices will not be considered.

Experience in unrelated healthcare roles, general customer service, medical billing only, or non-US authorization processes does not satisfy this requirement.

We are seeking an experienced Prior Authorization Specialist with strong background in US specialty medication authorizations. This role requires reviewing clinical documentation, verifying insurance benefits, submitting medication authorizations, and managing denials and appeals efficiently.

Duties

• Verify insurance benefits for drug and procedure orders (Commercial, Medicare, Medicaid)
• Determine pharmacy vs. medical benefit requirements when applicable
• Obtain appropriate authorizations by completing payer-specific forms and clinical questionnaires
• Review medical notes, diagnosis information, and treatment history to answer clinical questions accurately
• Submit and manage authorizations through, payer portals, fax, or phone
• Track pending authorizations and follow up until resolution
• Prioritize and manage STAT/urgent requests appropriately
• Communicate with MDs and NPs regarding denials, treatment plan updates, and Letters of Medical Necessity (LMNs)
• Assist patients with copay assistance or patient assistance programs when needed
• Enroll patients into navigation programs and obtain consent
• Document all actions clearly in internal systems and case trackers
• Participate in team meetings to resolve patient access challenges and improve workflow

Required Skills & Experience

• Minimum 2 years of US-based specialty medication prior authorization experience
• Experience managing other PA Specialists preferred
• Direct experience supporting GI, Dermatology, Rheumatology, Urology and Allergy medication authorizations required
• Strong understanding of US insurance plans (Commercial, Medicare, Medicaid)
• Experience reviewing EMR/EHR clinical documentation
• Strong attention to detail and structured documentation habits
• Fluent English (written and verbal)
• Ability to work without supervision

Work Location: Remote