Prior Authorizations Specialist - Medellín

Full Time - On-site, Direct Hire

RV Staffing is a fast-moving company based in Medellín, Colombia, supporting U.S. organizations through high-quality nearshore talent and operational solutions. We combine locally fluent professionals with strong technology, process, and service capabilities to help our clients build efficient, scalable teams. Our approach is built around high-touch support, operational excellence, and AI-augmented workflows, with a strong focus on delivering reliable service and meaningful results for the organizations and patients we support.

Position Summary:

The Prior Authorization & Patient Engagement Specialist serves as a key point of contact for patients, healthcare providers, and insurance companies, combining prior authorization management, insurance coordination, patient support, and prospective patient outreach. This role is responsible for preparing and tracking authorization requests, resolving documentation gaps, communicating administrative next steps to patients, and following up with prospective or referred patients to support scheduling and continuity of care. The position requires strong attention to detail, clear communication, proactive follow-up, and experience navigating U.S. healthcare insurance processes.

What You'll Do:

Prior Authorization & Insurance Management

- Review clinical documentation and payer requirements to prepare accurate authorization requests for procedures, treatments, and medications.

- Submit and track authorizations through payer portals, electronic platforms, fax, and phone.

- Verify insurance eligibility, benefits, referrals, and authorization requirements.

- Proactively follow up on pending, delayed, or denied authorizations and coordinate supporting documentation or reconsiderations.

- Identify documentation gaps and work with clinical teams to resolve issues promptly.

- Maintain accurate records of submissions, determinations, follow-ups, and payer requirements.

Patient Engagement & Customer Service

- Serve as a primary point of contact for patients regarding insurance requirements, authorization status, appointments, and administrative next steps.

- Handle inbound and outbound calls, emails, and approved communication channels with professionalism and empathy.

- Explain insurance and administrative processes clearly without providing clinical advice or guaranteeing coverage.

- Follow up with patients regarding missing information,



insurance verification, appointment readiness, and outstanding requirements.

- Resolve routine concerns and escalate complex billing, coverage, or clinical questions appropriately.

- Document patient interactions, follow-up attempts, and relevant updates while protecting confidential information.

Patient Outreach & Scheduling

- Conduct outbound outreach to prospective and referred patients who have expressed interest in services or have not completed the intake or scheduling process.

- Respond promptly to new patient inquiries and provide clear information about the administrative steps required to access care.

- Maintain an organized pipeline of prospective patients, tracking contact attempts, engagement status, follow-up dates, and scheduling outcomes.

- Re-engage patients who have postponed or not completed scheduling, where appropriate and permitted.

- Coordinate with scheduling, intake, and clinical teams to support a smooth transition from inquiry to appointment.

- Track outreach activity and performance metrics such as response rates, follow-up completion, and lead-to-appointment conversion.

Clinical Documentation & Coding

- Review patient charts and clinical documentation to ensure authorization requests contain required supporting information.

- Apply working knowledge of CPT and ICD-10 codes to validate procedure and diagnosis information.

- Coordinate with providers and clinical staff to obtain missing records, treatment details, and supporting documentation.

- Develop familiarity with pain management procedures, musculoskeletal conditions, and relevant treatment pathways.

- Escalate clinical questions and medical necessity determinations to licensed providers or designated clinical personnel.

Scheduling, Workflow & Coordination

- Monitor schedules to identify services requiring insurance verification or prior authorization.

- Coordinate authorization timelines with scheduling teams to minimize avoidable appointment delays.

- Prioritize urgent requests, upcoming procedures, new patient inquiries, and outstanding follow-ups.





- Maintain accurate information across EMR/EHR systems, CRM platforms, payer portals, and internal tracking tools.

- Communicate authorization, scheduling, and patient intake updates to clinical, administrative, and billing teams.

- Identify opportunities to improve authorization workflows, patient engagement, and scheduling readiness.

What You'll Bring To The Team:

- At least 2 years of experience in prior authorization within the U.S. healthcare system.

- Hands-on experience working with insurance companies, payer requirements, and authorization processes.

- Strong understanding of insurance eligibility, benefits, referrals, and authorization workflows.

- Working knowledge of CPT and ICD-10 coding.

- Experience reviewing clinical documentation and coordinating with providers or clinical teams.

- Strong patient communication and customer service skills, with a professional and empathetic approach.

- Experience handling inbound and outbound calls and conducting patient or lead follow-up.

- Strong organizational skills and the ability to manage multiple authorizations, patients, deadlines, and follow-ups simultaneously.

- Proactive follow-up, problem-solving, attention to detail, and accurate documentation.

- Experience with EMR/EHR systems, CRM platforms, payer portals, and healthcare administrative tools.

- Ability to communicate clearly in English and handle sensitive patient information confidentially.

- Familiarity with pain management, musculoskeletal care, or other specialty healthcare environments is a strong advantage.

​​​​​​​We Offer You:

- Monday to Friday availability with schedules from 8AM to 5PM

- Equipment and work station

- One-of-a-kind company values and teamwork culture as well as a meaningful mission and challenging work.

- Opportunities to work in a fast-paced startup environment supportive of teamwork, ownership, and purpose.

- Recognition and visibility for individual impact

- Direct Hire Agreement with our US company and USD compensation

​​​​​​​​​​​​​​At RV Holdings S.A.S., we promote an inclusive, diverse, and respectful work environment. We value talent regardless of race, ethnicity, gender, sexual orientation, gender identity, age, beliefs, nationality, or disability status. All selection processes are conducted based on the competencies, skills, and experience of each individual

📌 Prior Authorizations Specialist (Medellín)
🏢 Importante empresa
📍 Medellín