Prior Authorization Specialist

2 weeks ago


Davao City, Davao, Philippines Connext Global Solutions Inc Full time

The Authorization Specialist is responsible for managing the authorizations and referrals for medical services. This role involves reviewing the medical history of potential patients, verifying information from referring physicians, ensuring insurance coverage, and monitoring the schedule for add-on patients. The Authorization Specialist ensures all necessary authorizations are in place for appointments or procedures to proceed smoothly.

Job Description
• Complete authorizations and referrals for medical services, including appointments and procedures.

• Review patients' medical histories to ensure accurate and complete information.

• Contact insurance companies to verify coverage and obtain necessary approvals.

• Contact referring physicians to gather additional information or clarify details as needed.

• Monitor the schedule for add-on patients to identify and resolve potential conflicts.

• Ensure all prior authorizations are obtained before appointments or procedures.

• Input new patient information into the system and update existing records.

• Maintain accurate and up-to-date records of all authorizations and referrals.

• Complete and process billing documentation related to authorizations and referrals.

• Assist with the preparation and submission of insurance claims as needed.

• Perform other clerical tasks as required to support the administrative functions of the department.

Required Qualifications
• Knowledgeable with medical terms used in patient records and insurance documentation.

• Familiarity with different types of insurance plans, coverage details, and authorization requirements.

• Proficiency in navigating and updating patient records digitally, ensuring accuracy and confidentiality.

• Strong organizational and time-management abilities with the ability to manage multiple tasks, prioritize workload, and meet deadlines.

• Clear and coherent in both written and verbal communication skills to effectively convey information to patients, healthcare providers, and insurance representatives.

• Basic knowledge of Microsoft Office Suite for documentation, data analysis, and communication.

• Meticulous attention to detail with the ability to identify discrepancies in records, resolve billing issues, and ensure all information is accurate.

•Ability to adhere to industry standards and best practices in billing and authorization processes.

Your application will include the following questions:

How many years' experience do you have as an Authorization Officer?

Connext Global Solutions Inc

Information & Communication Technology

Connext Global Solutions helps businesses solve the staffing challenges and enable client growth with their innovative remote staffing and process outsourcing solutions. Connext powers small and medium enterprises by helping build, train, and manage excellent, highly functioning remote teams.

Originally established in 2014 to address specific pain points that we experienced in the traditional outsourcing model, Connext has grown from a local business services provider to a booming global enterprise with a growth rate exceeding 80%. We have more than doubled our growth since 2019 and now support middle-market companies across the United States and Europe.

Our client support centers are located Angeles City, Pampanga where we provide the highest caliber: Connext provides client-focused bespoke solutions to clients across all industries.

The Connext offshore team of industry experts include the following:

Senior CPAs, CPAs, Staff Accountants, and Accounting Techs

Real Estate Title and Escrow Specialists

IT/WEB Developers and Administrators

Nurses and Healthcare Claims Processors

QA and Data Analytics Specialists

Graphic Designers and System Engineers

HR and Payroll Service Professionals

Technical Support

Data Entry Specialists

Customer Service Representatives

and More

Core Values

Make It Fun

Be Transparent

Hire The Best

Take Ownership

Foster Teamwork

Do What's Right

Put Customers First

Go Above and Beyond

Connext Global Solutions helps businesses solve the staffing challenges and enable client growth with their innovative remote staffing and process outsourcing solutions. Connext powers small and medium enterprises by helping build, train, and manage excellent, highly functioning remote teams.

Originally established in 2014 to address specific pain points that we experienced in the traditional outsourcing model, Connext has grown from a local business services provider to a booming global enterprise with a growth rate exceeding 80%. We have more than doubled our growth since 2019 and now support middle-market companies across the United States and Europe.

Our client support centers are located Angeles City, Pampanga where we provide the highest caliber: Connext provides client-focused bespoke solutions to clients across all industries.

The Connext offshore team of industry experts include the following:

Senior CPAs, CPAs, Staff Accountants, and Accounting Techs

Real Estate Title and Escrow Specialists

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