Prior Authorization Quality Analyst
1 day ago
Qualifications Must hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review is preferredStrong familiarity with EPIC, MCG, or InterQual guidelines requiredDemonstrated job stability, with a consistent employment history and minimal transitions Job Description Audit Completing QA audits for their processes by following the QIPProviding feedback to team members on all errorsEscalating any anomalies / trends / Compliance issuesPerforming the actual production work to keep abreast of the latest updates and practical scenariosParticipating in client calls to capture process updates and monitoring compliance to the updates Process Contact insurance carriers to verify patients insurance eligibility, benefits, and requirements.Request, track, and obtain pre-authorization from insurance carriers within time allotted for medical and services.Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.Prioritize the incoming authorizations by level of urgency to the patient.Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.Respond to clinical questions regarding payer medical policy guidelines
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Prior Authorization Specialist
1 week ago
Taguig, National Capital Region, Philippines Access Healthcare Full time ₱300,000 - ₱360,000 per yearAccess Healthcare is looking for motivated and detail-oriented individuals to join our Healthcare Prior Authorization team.Key Responsibilities:Review and process prior authorization requests from healthcare providers.Verify patient insurance coverage and ensure compliance with payer requirements.Coordinate with healthcare providers, insurance companies, and...
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PHRN - Prior Authorization
4 weeks ago
Taguig, Philippines HRTX Full timeAbout the job PHRN - Prior Authorization Quality Auditor hiring Clinical Authorization Process.Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder) Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience ...
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Prior Authorization Nurse
2 weeks ago
Taguig, Philippines HR TechX Corp. Full timeOverview Join to apply for the Prior Authorization Nurse - PHRN (QA) role at HR TechX Corp. Position: Clinical/Prior Authorization - Quality Auditor Qualifications Must hold an active PHRN license (not a USRN license holder) Must have at least solid 4 to 7 years experience in Clinical/Prior Authorization or Utilization Review Relevant experience as a Quality...
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Prior Authorization Specialist
1 day ago
Taguig, Philippines HRTX Full timeWe are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical procedures, diagnostic tests, and medications from insurance providers. You will serve as a key liaison between healthcare providers, patients, and insurance companies...
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Prior Authorization Nurse
2 weeks ago
Taguig, Philippines HRTX Full timeAbout the job Prior Authorization Nurse - PHRN (QA) Position: Clinical/Prior Authorization - Quality Auditor Qualifications: Must hold an active PHRN license (not a USRN license holder) Must have at least solid 4 to 7 years experience in Clinical/Prior Authorization or Utilization Review Relevant experience as a Quality Auditor in Clinical Services...
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Prior Authorization Nurse
1 day ago
Taguig, Philippines HRTX Full timePosition: Clinical/Prior Authorization - Quality Auditor Qualifications: Must hold an active PHRN license (not a USRN license holder)Must have at least solid 4 to 7 years experience in Clinical/Prior Authorization or Utilization ReviewRelevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment (preferred only, not...
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PHRN - Prior Authorization Nurse
4 days ago
Taguig, National Capital Region, Philippines AUMTREND PH INC Full time ₱780,000 per yearPosition SummaryThe Prior Authorization Nurse (PHRN) will support the review and submission of prior authorization requests for behavioral health treatments, medications, or services. The nurse will review clinical documentation to ensure accuracy and medical necessity, complete required payer forms, and work closely with administrative support staff to...
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Prior Authorization Specialist
2 weeks ago
Taguig, Philippines HRTX Full timePrior Authorization Specialist (PHRN - Registered Nurse) Job openings: Prior Authorization Specialist (PHRN - Registered Nurse) About the job Prior Authorization Specialist (PHRN - Registered Nurse) We are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining...
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Prior Authorization Specialist
2 weeks ago
Taguig, Philippines HR TechX Corp. Full timePrior Authorization Specialist (PHRN - Registered Nurse) We are seeking a detail-oriented and organized Prior Authorization Specialist to join our healthcare team. In this role, you will be responsible for obtaining prior authorizations for medical procedures, diagnostic tests, and medications from insurance providers. You will serve as a key liaison between...
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PHRN - Prior Authorization
1 day ago
Taguig, Philippines HRTX Full timeQuality Auditor hiring Clinical Authorization Process. Onsite, Night Shift, Mon-Friday Qualifications Must hold an active PHRN license (not a USRN license holder)Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization...
