Team Lead Clinical Authorization
7 days ago
Job Title: Team Leader Pharmacy Authorization (RN) Location: McKinley, Taguig City Work Set-up: Onsite OUR COMPANY AGS Healthis more than a revenue cycle management company–we’re a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health systems, physician groups, and academic medical centers in the U.S. With expert insight into modern revenue cycle practices, the company pairs cutting-edge technology with college‑educated, trained RCM experts to help clients optimize workflows, maintain compliance, prevent revenue leakage, and achieve a high‑performance revenue cycle. AGS Health employs more than 12,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems. RESPONSIBILITIES Team Management Provide the team with the company’s vision and the objectives of all processes. Have excellent people management skills to ensure adequate production and quality SLAs (service level agreements) are met. Provide adequate training and knowledge sharing to the team by conducting daily and weekly meetings which are documented and acknowledged by the team. Monitoring daily production output and validating the same by means of timesheet approvals. Monitoring daily quality reviews of the quality audit team to ensure feedback is provided to the team and identified areas of concern are reviewed and completed in a timely manner. Monitoring and adhering to the company policies regarding leave and absenteeism within the team. Provide monthly performance report to the team on production & quality achievements and their areas for improvement. Serve as a SPOC (single point of contact) to communicate and resolve interface and integration issues with other teams. Adequate staffing is allocated within the various processes that need to be reported back to the client. Control Talent Retention to the minimum – attrition. Process Handling Contact insurance carriers to verify patient’s 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. COMPETENCIES, SKILLS AND OTHER REQUISITES Excellent written and spoken English. Unflinching integrity and personal work ethics. Self‑starter who strives for self and team excellence. Flair for client satisfaction. Attention to detail and concern for accuracy. Excellent time management skills and multi-tasking ability. Excellent team player. Compliant to rules and regulations. ACADEMIC AND PROFESSIONAL BACKGROUND Academic qualification for this role is a graduate in Nursing. Required Certifications/Licensure: Registered Nurse currently licensed. #J-18808-Ljbffr
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PHRN – Clinical Authorization
3 weeks ago
Taguig, Philippines Go-Get Data Consultancy Full timeOverview Job title: PHRN – Clinical Authorization Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building Work schedule: Weekdays Night Shift schedule, Fixed Weekends Off Salary: 45K to 50K package if licensed PHRN, salary for approval if non-licensed Responsibilities Contact insurance carriers to verify patient’s insurance eligibility,...
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Taguig, Philippines HRTX Full timeAbout the job PHRN - Utilization Review / Clinical Authorization We'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...
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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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Team Lead Pharmacy Authorization
2 days ago
Taguig, National Capital Region, Philippines AGS health Full time ₱2,000,000 - ₱2,500,000 per yearJob Title: Team Leader Pharmacy Authorization (RN)Location: McKinley, Taguig CityWork Set-up: OnsiteOUR COMPANYAGS Health is more than a revenue cycle management company–we're a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading...
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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
2 weeks ago
Taguig, Philippines Nezda Technologies, Inc. Full timePosition Title PHRN Quality Auditor - Prior/Clinical Authorization Location McKinley, Taguig Work Set-up Full Onsite | Night Shift Type Direct 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...
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PHRN - Prior Authorization
4 weeks 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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PHRN - Prior Authorization
3 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 in...
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PHRN - Prior Authorization
4 weeks 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
3 days 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...
