Prior Authorization Specialist
1 day ago
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 healthcare providers, patients, and insurance companies to ensure timely and accurate approval of services, helping to minimize delays in patient care. About the Role As a Prior Authorization Specialist, your primary responsibilities include reviewing medical documentation and verifying insurance coverage to determine the need for prior authorization for procedures, tests, and prescriptions. You will submit prior authorization requests to insurance carriers, follow up on pending approvals, and ensure all documentation is complete and compliant with payer requirements. In collaboration with healthcare providers and clinical staff, you will gather necessary information to support the authorization process and communicate updates to patients regarding the status of their approvals. Additionally, you will maintain accurate records in the electronic health record (EHR) system, respond to insurance inquiries, appeal denied requests when appropriate, and stay informed on payer policy changes to help reduce authorization delays. Strong attention to detail, knowledge of insurance guidelines, and excellent communication skills are essential for success in this role. Qualifications: Must possess an active PHRN licenseExperience as a Quality Auditor in Clinical Services within a healthcare BPO is preferred; alternatively, 4 to 7 years of focused experience in Clinical Authorization or Utilization Review.Proficient in using EPIC, MCG, or InterQual 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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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
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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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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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...
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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 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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Prior Authorization Quality Analyst
1 day ago
Taguig, Philippines HRTX Full timeQualifications 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...
