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Prior Authorization

3 months ago

Manila, National Capital Region, Philippines Omega Healthcare Management Services Inc. Full time

Job Purpose

Authorizations Management is a service delivery team that works to obtain prior authorizations and referrals for medical practices throughout the US. We work to take the burden off practices by initiating the authorization process as soon as providers order medical services.

Job Duties and Responsibilities

· Prioritize incoming authorization and referral requests according to queue urgency

· Review patient's clinical and chart documentation related to the service submitted by the provider's office

· Obtain and/or follow up on authorization and referral requests from the patient's payer/s through any of the following methods—depending on the payer's policy:

o Perform outbound calls to payer's authorization department

o Access payer's authorization online portal

o Submit faxes to payer's authorization department

· Respond to payer's clinical questions to be able to proceed with the authorization and referral requests

· Obtain and/or follow up payer's peer-to-peer review requirements and send them back to provider's office for the actual initiation

· Cater inbound calls from payers and perform necessary actions required for the task

· Listen and review voicemail messages from payers then perform necessary actions required for the task

Required Skills

· Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes

· Comprehensive understanding of Medical Terminology

· Prior experience in processing multispecialty authorizations including contact with payers

· Experience in medical coding specially for Cardiac procedures

· Experience with general computer software (Internet, Word, Outlook, PDF required)

· Proficiency to learn new software programs quickly

· Excellent customer service skills: communicates clearly and effectively

· Excellent verbal and written communication skills

· Professional and effective interaction skills with co-workers, clients, providers, and vendors

· Proven ability to work well individually and as a team member

· Strong attention to detail

· Ability to follow company and account-specific standard operating procedures and policies

· Ability to adapt to constantly changing environment

· Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand

· Ability to remain organized with multiple interruptions

· Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies

· Ability to comfortably receive constructive feedback

Required Experience

Candidates must possess a bachelor's degree:

o Graduate of Bachelor of Science in Nursing with active PH Registered Nurse License

· 1–2 years of experience in business process outsourcing preferably