PHRN – Clinical Authorization
4 weeks ago
Overview
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, 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
- Active PHRN license preferred but not required, as long as the candidate is a BS Nursing graduate
- Must not hold a USRN license
- At least 6 months of experience in Clinical or Prior Authorization, with familiarity in medical necessity guidelines or criteria
- At least 6 months of bedside nursing experience preferred but not required
- Knowledge in EPIC or any Electronic Health Record preferred
- Must be amenable to start immediately, onboarding will start on Wednesday, April 30
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