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 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
We are seeking an experienced Prior Authorization & Medical Benefits Specialist with a strong background in US specialty medication authorizations, including buy-and-bill, infusion, biologic, and clinic-administered medications. This role requires reviewing clinical documentation, verifying medical and pharmacy benefits, submitting medication authorizations, and managing denials and appeals efficiently. This is a fully offshore/remote position, but candidates should have direct, hands-on experience working with US healthcare practices (clinic, infusion center, specialty practice, or buy-and-bill team).
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
Required Skills & Experience
- Minimum 2 years of US-based specialty medication prior authorizations, buy-and-bill, infusion, biologic, or clinic-administered medications
- Experience managing a team of buy and bill specialists preferred
- Direct experience supporting GI, Dermatology, Rheumatology, Allergy, Oncology, or Urology 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
- Ability to work US daytime hours
Application Question(s):
- A summary of your relevant experience with US-based buy-and-bill prior authorizations and medical benefits investigations?
- List 5 infusion, biologic, or clinic-administered medications for which you have frequently completed buy-and-bill prior authorizations and can discuss during an interview?
- Have you worked in a clinic, infusion center, or specialty practice completing buy-and-bill prior authorizations? If so, please elaborate on what payer portals or platforms you used to submit these and verify medical benefits
- Why are you looking to leave (or have already left) your previous employer?
Work Location: Remote
Job Type: Full-time
Pay: ₹70,000.00 - ₹99,000.00 per month
Application Question(s):
- Why are you looking to leave (or have already left) your previous employer?
- A summary of your relevant experience with US-based buy-and-bill prior authorizations and medical benefits investigations?
- List 5 infusion, biologic, or clinic-administered medications for which you have frequently completed buy-and-bill prior authorizations and can discuss during an interview?
- Have you worked in a clinic, infusion center, or specialty practice completing buy-and-bill prior authorizations? If so, please elaborate on what payer portals or platforms you used to submit these and verify medical benefits
Work Location: Remote
