Prior Authorization Specialist Remote

Salary: PHP 40,000/month + Performance Bonuses Benefits: 10 days PTO, Annual Appraisal, Career Growth Opportunities, Healthcare Benefits Schedule: U.S. Hours About the Role SmartScale360 is looking for a Medicaid Staffing Coordinator / Case Processor for our U.S.-based clients. This role is responsible for coordinating caregiver schedules, processing Medicaid service cases, and ensuring all services align with authorized care plans and Medicaid compliance requirements. This role is perfect for candidates with scheduling or healthcare administrative experience, strong organizational and communication skills, and the ability to manage multiple schedules, cases, and documentation tasks in a fast-paced environment. Key Responsibilities: Scheduling & Staffing • Coordinate scheduling of Care Professionals for clients under the Oklahoma ADvantage Waiver Program • Manage caregiver schedules and ensure services align with authorized Medicaid service units and care plans • Handle time-off requests, schedule changes, and immediate caregiver call-offs to maintain service coverage • Ensure caregivers properly clock in and out through Authenticare and WellSky systems Case Processing & Documentation • Review and process Medicaid service authorizations, service plans, and required documentation • Maintain accurate client records, service units, and case documentation in agency systems • Perform case processing tasks and daily monitoring of the Harmony system for new clients or updates • Track client service changes, renewals, and authorization updates • Ensure documentation complies with Medicaid and agency policies Operations & Coordination • Communicate with case managers, clients, families, and state program representatives regarding scheduling updates and service needs • Perform daily system checks to monitor scheduling coverage and service delivery • Follow up on missed caregiver clock-ins and clock-outs • Ensure scheduled services align with approved care plans and Medicaid units • Provide administrative and staffing support to office leadership Required Qualifications • At least 1 year experience in scheduling, administrative support, healthcare coordination, or Medicaid-related roles • Strong organizational, administrative, and documentation skills • Strong English communication skills (written and verbal) • Ability to manage multiple cases, schedules, and deadlines simultaneously • Tech-savvy with the ability to quickly learn new systems and software • Strong attention to detail and process-driven mindset Systems & Tools Candidates may work with the following platforms: • Harmony – Client case tracking and management • WellSky – Home care scheduling and service tracking • Authenticare – Electronic visit verification (EVV) and caregiver clock-in system Work-From-Home Requirements • Device: Intel i5 processor with 8 GB RAM minimum • Backup device, internet connection, and power supply required • Ability to work through a secure VPN connection Preferred Qualifications • Experience with Medicaid waiver programs or home care operations • Familiarity with healthcare scheduling or care coordination roles • Experience using WellSky, Harmony, Authenticare, or similar home care systems • Experience supporting U.S.-based healthcare or home care accounts Why Join SmartScale360? Join a supportive team, advance your recruitment career, and play a key role in connecting top talent with leading U.S. clients. Apply now and help us build great teams across the U.S.!