- Prior Authorization Management: Review and evaluate medical service requests, including procedures, tests, surgeries, and medications, to determine if prior authorization is required. Gather all relevant medical documentation, such as medical records, test results, and clinical notes, to support the authorization request.
- Insurance Verification: Verify patient insurance coverage, including benefits, eligibility, and limitations. Obtain and document necessary insurance information to ensure accurate billing and reimbursement.
- Documentation and Communication: Prepare and submit prior authorization requests to insurance companies or third-party payers, adhering to their specific guidelines and requirements. Maintain accurate and organized records of all authorization requests, follow-up activities, and outcomes. Communicate with healthcare providers, insurance companies, and patients to obtain additional information, clarify requirements, and provide updates on the status of authorizations.
- Policy and Compliance: Stay up-to-date with insurance policies, guidelines, and industry regulations related to prior authorizations. Ensure compliance with all legal and regulatory requirements, including patient privacy and confidentiality (HIPAA).
- Appeals and Denials: Assist with appeals and denials related to prior authorizations, working closely with healthcare providers and insurance companies to gather necessary information and submit appeals within specified timelines. Analyze denials and identify trends or areas for improvement to minimize future denials.
- Quality Assurance: Perform periodic audits of prior authorization processes to identify any gaps or inefficiencies. Collaborate with team members and stakeholders to implement process improvements and enhance overall efficiency and accuracy.
- Team Collaboration: Collaborate effectively with healthcare providers, nurses, medical assistants, billing staff, and other members of the healthcare team to ensure a smooth and coordinated workflow. Share knowledge, provide training, and offer guidance on prior authorization processes and best practices.
- High school diploma or equivalent. (some positions may require an associate's or bachelor's degree in a related field)
- Prior experience in healthcare administration, medical billing, or insurance coordination is highly preferred.
- Strong knowledge of medical terminology, CPT codes, ICD-10 codes, and insurance procedures.
- Familiarity with insurance plans, prior authorization requirements, and reimbursement processes.
- Excellent communication skills, both written and verbal, with the ability to effectively interact with healthcare professionals, insurance companies, and patients.
- Attention to detail and ability to organize and prioritize tasks in a fast-paced environment.
- Strong analytical and problem-solving skills, with the ability to navigate complex insurance processes and resolve issues efficiently.
- Proficiency in using electronic health records (EHR) systems, billing software, and other relevant computer applications.
- Note: The above job description provides a general overview of the responsibilities and requirements for a Prior Authorization Specialist. Actual job duties may vary depending on the specific healthcare setting, organizational policies, and regional regulations.
- Prior Authorization experience required.
-
Prior Authorization Specialist
6 araw ang nakalipas
BizForce Philippines, Quezon City, Pilipinas Buong oras#1 PH Workforce Delivering to the US · MedCore Solutions, the Medical Division of Bizforce, is seeking a skilled Prior Authorization Specialist - Behavioral Health to join our growing team. The Prior Authorization Specialist we be primarily responsible for obtaining all types of ...
-
PHRN Healthcare account. with prior authorization review exp 50k
3 oras ang nakalipas
BPO-services manila, Pilipinas Buong orasWe currently have an opening in our PHRN Healthcare account. We're seeking individuals with prior authorization review experience, and it's essential that your PHRN license is still active. · The position involves 4 months of onsite work, with the remainder being work from home. ...
-
Team Lead PHRN US Healthcare experience prior authorization Rcm
3 oras ang nakalipas
BPO-services manila, PilipinasTeam Lead PHRN US Healthcare experience prior authorization Rcm · Must have US Healthcare experience prior authorization/RCM/UMR/Claims/Billing/Pharmaceutical/Clinical Appeals · Can work on-site in Ortigas. · can start asap. · amenable working the graveyard shift. · 40k to 50k ...
-
Team Lead PHRN US Healthcare experience prior authorization Rcm
2 araw ang nakalipas
BPO-services Manila, Pilipinas Buong orasTeam Lead PHRN US Healthcare experience prior authorization RcmMust have US Healthcare experience prior authorization/RCM/UMR/Claims/Billing/Pharmaceutical/Clinical AppealsCan work on-site in start asap. amenable working the graveyard shift. 40k to 50k ...
-
Assistant Quality Manager US Healthcare experience prior auth rev
2 araw ang nakalipas
BPO-services Manila, Pilipinas Buong orasAssistant Quality Manager US Healthcare experience prior auth review. Must have US Healthcare experience prior authorization/RCM/UMR/Claims/Billing/Pharmaceutical65k to 95k. can work onsite. can start asap. amenable working the graveyard shift. ...
-
Assistant Quality Manager US Healthcare experience prior auth rev
3 oras ang nakalipas
BPO-services manila, PilipinasAssistant Quality Manager US Healthcare experience prior auth review. · Must have US Healthcare experience prior authorization/RCM/UMR/Claims/Billing/Pharmaceutical · 65k to 95k. · can work onsite. · can start asap. · amenable working the graveyard shift. ...
-
Quality Assurance Lead/Supervisor US Healthcare experience prior
3 oras ang nakalipas
BPO-services manila, PilipinasQuality Assurance Lead/Supervisor US Healthcare experience prior. · must have US Healthcare experience prior authorization/RCM/UMR/Claims/Billing/Pharmaceutical/B&E/Clinical Appeals · Can start asap. · can work onsite. · amenable working the graveyard shift. · 40k to 50k ...
-
Quality Assurance Lead/Supervisor US Healthcare experience prior
2 araw ang nakalipas
BPO-services Manila, Pilipinas Buong orasQuality Assurance Lead/Supervisor US Healthcare experience have US Healthcare experience prior authorization/RCM/UMR/Claims/Billing/Pharmaceutical/B&E/Clinical AppealsCan start asap. can work onsite. amenable working the graveyard shift. 40k to 50k ...
-
Quality Assurance Manager Strong BPO US Healthcare experience
2 araw ang nakalipas
BPO-services Manila, Pilipinas Buong orasQuality Assurance Manager Strong BPO US Healthcare experienceStrong BPO US Healthcare experience in any kind or line of business process (e.g. claims, clinical appeals ,billing, benefits eligibility but preferably RCM, UMR and prior authorization experience) and strong six sigma ...
-
US Healthcare Analyst
6 araw ang nakalipas
Cobden and Carter International Inc Metro Manila / NCR, Pilipinas Buong orasWork set-up: Hybrid, Night shift · Taguig · Qualifications:3 years of working experience dealing with US health and welfare plans, ideally gained in a benefit consulting/brokerage firm, Health Plan, Third Party Administrator, Regulatory Agency, Legal/Compliance Firm, or insuranc ...
-
Customer Service Representative
6 araw ang nakalipas
Collabera Technologies Private Limited Inc Metro Manila / NCR, Pilipinas Buong orasServes customers by providing product and service information and resolving product and service problems. · • Opens customer accounts by recording account information. · • Maintains customer records by updating account information. Resolves product or service problems by clarif ...
-
Quality Assurance Manager Strong BPO US Healthcare experience
3 oras ang nakalipas
BPO-services manila, PilipinasQuality Assurance Manager Strong BPO US Healthcare experience · Strong BPO US Healthcare experience in any kind or line of business process (e.g. claims, clinical appeals ,billing, benefits eligibility but preferably RCM, UMR and prior authorization experience) and strong six sig ...
-
HMO Medical Benefits Associate
6 araw ang nakalipas
Hive Health (YC S21) Philippines, Manila, Pilipinas Buong orasAbout Us · Group of Companies, which is on a mission to provide the best-in-class health plans for small-medium enterprises (SMEs) in the Philippines. · HPPI's 30+ years of providing care, combined with Hive Health's innovative tech capabilities, enables the Hive Health Group of ...
-
Accounting Assistant
6 araw ang nakalipas
BIMCAP Philippines, Manila, Pilipinas Buong orasBIMCAP Family · BIMCAP is an international BIM outsourcing company with an expanding portfolio of cultural, infrastructure, and commercial projects around the world. We are leaders in BIM innovation, growth of BIM talent, and unique for our supportive family-like culture. · Role ...
-
Senior Information Security and Technology Risk Governance
1 linggo ang nakalipas
SM Retail Inc Metro Manila, PilipinasSenior Information Security & Technology Risk is to assist in the development and delivery of a comprehensive Information Security Control Program for SM Retail, Inc. to assure that information - created, acquired, or maintained by the Company and its authorized users, is utilize ...
-
Clinical Instructor
5 araw ang nakalipas
Recruiter PH Manila, Pilipinas Buong orasPrimary Duties and Responsibilities: · • Ensure that training and assessments happen as per statutory requirements. · • Give feedback and coach trainees on key job capabilities. · • Update and develop content as per client and business requirements. · • Ensure that all relevant i ...
-
Document Controller
6 araw ang nakalipas
ALSTOM Transport Constructions Philippines Inc. Philippines, Manila, Pilipinas Buong orasReq ID:455191 · At Alstom, we understand transport networks and what moves people. From high-speed trains, metros, monorails, and trams, to turnkey systems, services, infrastructure, signalling and digital mobility, we offer our diverse customers the broadest portfolio in the ind ...
-
VA Admin Assistant
6 araw ang nakalipas
Microsourcing Philippines Inc Metro Manila / NCR, Pilipinas Buong orasWith over 7,000 professionals across 9 delivery centers in the Philippines, MicroSourcing remains the country's largest offshoring solutions provider. · Virtual Admin Assistant, be 100% YOU with MicroSourcing · A Virtual Admin Assistant (With Healthcare Expe) is expected to: · ...
-
Clinical Instructor
3 oras ang nakalipas
Recruiter PH Manila, PilipinasPrimary Duties and Responsibilities: · • Ensure that training and assessments happen as per statutory requirements. · • Give feedback and coach trainees on key job capabilities. · • Update and develop content as per client and business requirements. · • Ensure that all relevant i ...
-
Virtual Administrative Assistant
6 araw ang nakalipas
Microsourcing Philippines Inc Metro Manila / NCR, Central Luzon, Southern Tagalog, Pilipinas Buong orasWith over 7,000 professionals across 9 delivery centers in the Philippines, MicroSourcing remains the country's largest offshoring solutions provider. · Virtual Admin Assistant, be 100% YOU with MicroSourcing · A Virtual Admin Assistant (With Healthcare Expe) is expected to: · ...
Medical Prior Authorization - Manila, Pilipinas - Med Supply US
Paglalarawan
Medical Prior Authorization-Insurance Verification SpecialistPosition Summary:
The Prior Authorization Specialist plays a crucial role in the healthcare industry by ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they are rendered or prescribed. They work closely with healthcare providers, insurance companies, and patients to gather and submit the necessary information to obtain prior authorizations. The primary objective of a Prior Authorization Specialist is to navigate the complex process of securing pre-approval for healthcare services, minimizing delays in treatment and optimizing reimbursement.
Key Responsibilities:
Qualifications and Skills:
&v=024){kind=logo}
