Prior Authorization & Medical Benefits Specialist (Buy and Bill)

Prior Authorization & Medical Benefits Specialist (Buy and Bill) Compensation: 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 medicationsDetermine pharmacy vs. medical benefit requirements when applicableObtain appropriate authorizations by completing payer-specific forms and clinical questionnairesReview medical notes, diagnosis information, and treatment history to answer clinical questions accuratelyObtain appropriate authorizations by completing payer-specific forms and clinical questionnairesSubmit and manage authorizations through, payer portals, fax, or phonePrioritize and manage STAT/urgent requests appropriatelyAssist patients with copay assistance or patient assistance programs when neededEnroll patients into navigation programs and obtain consentDocument all actions clearly in internal systems and case trackersParticipate in team meetings to resolve patient access challenges and improve workflowRequired Skills & Experience Minimum 2 years of US-based specialty medication prior authorizations, buy-and-bill, infusion, biologic, or clinic-administered medicationsExperience managing a team of buy and bill specialists preferredDirect experience supporting GI, Dermatology, Rheumatology, Allergy, Oncology, or Urology medication authorizations requiredStrong understanding of US insurance plans (Commercial, Medicare, Medicaid)Experience reviewing EMR/EHR clinical documentationStrong attention to detail and structured documentation habitsFluent English (written and verbal)Ability to work without supervisionAbility to work US daytime hoursApplication 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 benefitsWhy are you looking to leave (or have already left) your previous employer Work Location: Remote Job Type: Full-time Compensation: 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 benefitsWork Location: Remote .