Prior Authorization Specialist | Work From Home

3 weeks ago


Capital District, Philippines Connext Global Solutions Inc Full time

Join Our Team as a Prior Authorization Specialist The Prior Authorization Specialist is responsible for efficiently navigating the insurance landscape in the healthcare or pharmaceutical sector. They meticulously review and process benefits investigations for high-cost medications, secure prior authorizations when needed, and estimate medication costs based on insurance coverage. Key Responsibilities Analyze benefits inquiries on insurance platforms for high-cost medications. Verify the eligibility of patients for medication coverage. Initiate and complete the prior authorization process when necessary. Communicate with healthcare providers and insurance companies to secure authorizations. Calculate and estimate medication costs based on the benefits and insurance coverage obtained. Provide accurate cost information to patients and healthcare providers. Possess a comprehensive understanding of the distinction between a referral and a prior authorization. Demonstrate exceptional attention to detail in all tasks to prevent errors and ensure accurate processing. Maintain precise records and documentation for compliance and reference purposes. Qualifications Experience in healthcare or medical billing, insurance processing, or prior authorization. Strong knowledge of insurance procedures, medical terminology, and regulations. Familiar with various insurance plans and their specific requirements. Clear written and verbal communication skills for interacting with providers, insurers, and patients. Proficient in using insurance platforms and software for benefits verification and authorizations. Exceptional attention to detail to prevent errors in processing and documentation. Skilled in managing multiple cases and maintaining accurate records. Able to troubleshoot issues in benefits investigations and authorizations. Strong interpersonal skills with a focus on providing excellent customer service. Adaptable and eager to learn new systems and regulations. Why Connext? Competitive Compensation Perfect Attendance Bonus Company-Provided Equipment 25% Night Differential Pay Life and HMO Insurance Coverage 20 Leave Credits Good Company Culture #J-18808-Ljbffr



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