PHRN - Prior Authorization
1 week ago
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 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 I. 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 II. 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 Nurse
1 week 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 Nurse
1 week 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 Review Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment (preferred only, not...
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PHRN - Prior Authorization
6 days 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 Specialist
1 week 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 Specialist
1 week 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, National Capital Region, Philippines HRTX Full time ₱600,000 - ₱1,200,000 per yearPosition: Clinical/Prior Authorization - Quality AuditorQualifications: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 Specialist
2 weeks ago
Taguig, National Capital Region, Philippines HRTX Full time ₱120,000 - ₱250,000 per yearWe 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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Taguig, Philippines HRTX Full timeWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, TaguigSchedule: Night Shift | Monday to FridayHiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder)Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4 to...
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Taguig, Philippines HRTX Full timeWe're Hiring: PHRN Quality Auditor Clinical Services Location: Onsite, Mckinley, Taguig Schedule: Night Shift | Monday to Friday Hiring Target Date: Preferably by July 21, 2025 Salary Range: Up to 50k Qualifications Must hold an active PHRN license (Not a USRN holder) Prior experience as a Quality Auditor in a healthcare BPO clinical setting Alternatively, 4...
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PHRN Quality Auditor
7 days ago
Taguig, National Capital Region, Philippines Nezda Technologies, Inc. Full timePosition Title: PHRN Quality Auditor - Prior/Clinical AuthorizationLocation: McKinley, TaguigWork Set-up: Full Onsite | Night ShiftDirect Hire | Permanent role Qualifications: Must hold an active PHRN license With relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment Open for Associate/CSR with 4+ years of...
