Prior Authorization & Medical Benefits Specialist (Buy and Bill)
Pay: ₹70,000.00 - ₹105,000.00 per month
Work Hours:9:00 AM - 6:00 PM India's Timezone
(11:30 PM - 8:30 AM EST)
Remote | Offshore | Full-Time | (EST Hours)
Compensation: $800- $1150 per month
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 perks 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
Duties
- Verify insurance benefits for drug and procedure orders (Commercial, Medicare, Medicaid)
- Complete medical benefits investigations for buy-and-bill, infusion, biologic, injectable, and clinic-administered medications
- 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
- Obtain appropriate authorizations by completing payer-specific forms and clinical questionnaires
- Submit and manage authorizations through, payer portals, fax, or phone
- Prioritize and manage STAT/urgent requests appropriately
- 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