Benefits, Eligibility,

3 weeks ago

Lipa, Philippines Inersia AE. Consultant, PT Full time

Overview

Join to apply for the Benefits, Eligibility, & Prior Auths Specialist role at Inersia AE. Consultant, PT .

What You Will Be Doing
  • Benefits & Eligibility Oversight: Ensure the accuracy and timeliness of benefit and eligibility checks performed by our 3rd-party vendor. Escalate or directly resolve complex cases that require additional investigation, payer communication, or specialized follow-up.
  • Prior Authorization Escalation Management: Handle edge cases related to prior authorization submissions, such as denials, urgent approvals, or unclear payer requirements. Ensure providers have what they need to start or continue services without interruption.
  • Vendor Support & Partnership: Serve as the escalation point for the vendor, answering questions, clarifying requirements, and stepping in when situations fall outside standard workflows. Build a collaborative relationship to improve efficiency and accuracy.
  • Cross-Team Coordination: Work with Provider Success, Billing, and RCM teams to resolve escalated benefit or authorization issues quickly. Keep providers and internal stakeholders informed of resolution timelines and outcomes.
  • Documentation & Compliance: Maintain accurate records of escalations, payer communications, and final resolutions. Ensure documentation complies with payer policies, HIPAA, and Finni Health standards.
  • Continuous Process Improvement: Identify recurring edge cases or vendor pain points, and work with leadership to improve processes, training, or documentation to reduce future escalations.
  • Adaptable Responsibilities: As Finni Health grows, you may take on new responsibilities that support our mission and improve provider and patient experience.
About You
  • You are a problem-solver who thrives on untangling complex situations and ensuring patients get uninterrupted access to care. Based in the Philippines, you bring strong attention to detail, excellent follow-through, and confidence in working directly with payers and vendors to resolve issues.
  • Experience: 1–3 years in benefits verification, eligibility checks, prior authorizations, or healthcare operations. Hands-on experience resolving payer escalations is highly valued.
  • Problem-Solving: Strong ability to investigate, troubleshoot, and resolve complex benefit and authorization issues with persistence and accuracy.
  • Collaborative & Independent Contribution: Capable of working independently on escalations while keeping internal teams informed and aligned.
  • Administrative Acumen: Organized, detail-oriented, and confident in reviewing insurance documentation, payer guidelines, and vendor reports.
  • Communication & Collaboration: Excellent communicator, able to explain complex payer requirements clearly to providers, families, vendors, and internal teams.
  • Organizational & Time Management: Skilled at managing multiple escalations and prioritizing urgent cases without losing track of long-term follow-ups.
  • Tech Proficiency: Proficient in Google Suite, Slack, CRMs/support systems, and comfortable learning new EHR and RCM tools.
  • Mission Alignment: Passionate about Finni’s mission to democratize autism care by ensuring families experience smooth, uninterrupted access to services.
  • Adaptability & Agility: Thrives in a fast-paced startup, embraces change, and approaches ambiguity with a proactive, solution-focused mindset.
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