PHRN – Clinical Authorization

6 days ago

Taguig, Philippines Go-Get Data Consultancy Full time

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
Qualifications
  • 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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