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, efficient workflows, and consistent follow-up.
Job Summary
IMPORTANT: DO NOT APPLY IF YOU DO NOT MEET THIS REQUIREMENT
This position requires 3-10 years of direct, hands-on experience completing medication prior authorizations for Rheumatology.
Applicants must have recent experience completing specialty medication prior authorizations, benefits investigations, payer communications, denials, appeals, and specialty medication access workflows for US-based medical practices.
Experience limited to customer service, medical billing, pharmacy dispensing, or non-US authorization processes does not satisfy this requirement.
We are seeking an experienced Prior Authorization Specialist to manage specialty medication access from start to finish. This includes insurance verification, benefits investigation, prior authorization submission, appeals, patient assistance enrollment, pharmacy coordination, and ongoing follow-up to ensure patients receive therapy without unnecessary delays.
Responsibilities
- Verify insurance benefits for specialty medications (Commercial, Medicare, and Medicaid)
- Determine whether medications should be billed under the medical benefit or pharmacy benefit
- Complete payer-specific prior authorization forms and clinical questionnaires
- Review physician notes, diagnosis, laboratory results, treatment history, and supporting documentation
- Submit and manage prior authorizations through payer portals, CoverMyMeds, fax, and phone
- Track pending authorizations and proactively follow up until final determination
- Manage denials and prepare appeal documentation, including Letters of Medical Necessity (LMNs) when required
- Identify missing clinical information and coordinate with providers to obtain necessary documentation
- Assist patients with copay assistance programs, manufacturer support programs, and patient assistance foundations when appropriate
- Coordinate with specialty pharmacies, providers, and patients throughout the medication access process
- Prioritize urgent and STAT requests appropriately
- Document all activities accurately in EMR and internal tracking systems
- Collaborate with team members to improve turnaround times and patient access
Required Skills & Experience
- Minimum 3 years of specialty medication prior authorization experience in Rheumatology
- Experience supporting Rheumatology biologics and specialty medications
- Strong understanding of Commercial, Medicare, and Medicaid insurance plans
- Experience completing benefits investigations and determining medical vs. pharmacy benefit coverage
- Experience reviewing EMR/EHR clinical documentation
- Experience with payer portals, CoverMyMeds, fax, and phone authorization workflows
- Strong written and verbal English communication skills
- Excellent attention to detail and documentation skills
- Ability to work independently in a fully remote environment
- Experience mentoring or managing other Prior Authorization Specialists is a plus
Pay: $18.00 - $22.00 per hour
Application Question(s):
- Describe your experience completing prior authorizations for Rheumatology medications in a physician office, specialty clinic, or hospital. What EMR systems and payer portals have you used?
- Have you completed benefits investigations and determined whether medications should be billed under the medical benefit or pharmacy benefit? Please describe your experience.
- Why are you looking to leave (or why did you leave) your previous employer?
- List 5 Rheumatology specialty medications for which you have personally completed prior authorizations for.
Work Location: Remote
