Clinical Insurance & Authorization Specialist

Industry: Skilled Nursing / Healthcare

Position: Full-Time, Remote 9am-5pm EST

Pay: $ USD monthly

About the Role

We are seeking a Clinical Insurance & Authorization Specialist to support the reimbursement department of a healthcare organization managing multiple skilled nursing facilities across the United States.

This role is idóneo for someone with a nursing, medical assistant, or other clinical healthcare background who is comfortable communicating with insurance companies and learning the administrative and reimbursement side of U. S. healthcare.

The specialist will work closely with an experienced nurse who will provide training on the organization's insurance contracts, authorization requirements, payer criteria, and reimbursement processes.

Key Responsibilities

Contact insurance companies to obtain and follow up on patient authorizations. Review clinical information and understand whether patients meet payer criteria for continued coverage. Communicate confidently with insurance representatives regarding patient cases, coverage, and authorization requirements. Assist with retroactive authorizations and claims when necessary. Review and understand insurance contracts, payer requirements, and different reimbursement levels. Advocate for patient cases by clearly communicating relevant clinical information to insurance companies. Track outstanding authorizations, insurance issues, and follow-ups to ensure nothing falls through the cracks. Maintain accurate documentation of calls, authorizations, payer decisions, and required next steps.



Work closely with the reimbursement team and nursing staff to obtain any clinical information required by insurance companies. Support insurance and reimbursement processes across multiple skilled nursing facilities.

Qualifications

Nursing, medical assistant, or other clinical/medical background strongly preferred. Strong understanding of medical terminology and clinical documentation. Excellent English communication skills, particularly over the phone. Confident and assertive when speaking with insurance representatives — must be comfortable making calls and asking questions. Strong critical-thinking skills and ability to understand detailed payer criteria. Highly organized and able to manage multiple cases and follow-ups simultaneously. Comfortable learning U. S. healthcare insurance, authorization, and reimbursement processes. Detail-oriented, proactive, and able to work independently. Previous experience with U. S. health insurance, prior authorizations, utilization review, claims, or reimbursement is a major plus but not required for the right clinical candidate .

Ideal Candidate

The ideal candidate is someone with clinical training who may be looking to transition away from direct patient care into a healthcare administrative role. You should be comfortable reviewing clinical information, learning complex insurance requirements, speaking confidently with insurance companies, and advocating for appropriate patient coverage.

Training will be provided, so direct skilled nursing reimbursement experience is not required. We are looking primarily for someone who is clinically knowledgeable, intelligent, organized, confident on the phone, and able to learn quickly.

📌 Clinical insurance & authorization specialist (México)
🏢 Remote Hive
📍 México