Pharmacy Prior Authorization Specialist
4 weeks ago
EOR: One Workforce GlobalEmployment Type: Full-Time EmploymentWork Setup: 100% Onsite (Office location in either Eastwood, Clark or Muntinlupa)Work Schedule: Night Shift (Following U.S. Time Zone) Position Overview The Pharmacy Prior Authorization Specialist is responsible for handling and processing medication prior authorization (PA) requests with minimal patient interaction. This role involves coordinating with physicians, pharmacies, and insurance providers to ensure timely and accurate submission of PA documentation. A strong understanding of insurance processes, medication coverage guidelines, and bio-similar medications is essential for success in this role. Duties and Responsibilities Process and submit electronic prior authorization (ePA) requests for medications. Communicate with physicians, pharmacy staff, and insurance companies regarding PA requirements and status updates. Use platforms such as CoverMyMeds to complete and track prior authorization requests. Interpret and apply insurance policies, formulary guidelines, and coverage rules . Review medication classifications, including bio-similar vs. brand-name products , to determine appropriate PA documentation. Determine when to discontinue PA efforts based on coverage likelihood and workflow guidelines. Manage denials appropriately (no appeals or extensive pushback required within this role). Maintain accurate and compliant documentation throughout the PA process. Follow internal procedures to avoid unnecessary appeals and ensure efficient workflow. Job Requirements Pharmacy Knowledge: Understanding of medication names, dosing, therapeutic classes, and basic clinical terminology. Insurance & Coverage Literacy: Familiarity with insurance plans, formulary processes, and pharmacy benefit structures. Attention to Detail: Ability to follow structured workflows accurately and avoid errors in documentation. Systems Proficiency: Experience using CoverMyMeds , EMR/EHR systems, pharmacy software, or insurance authorization platforms. Communication Skills: Clear and professional communication with clinical teams and pharmacy staff. Judgment & Decision-Making: Ability to assess when to continue or discontinue PA processing based on guidelines. Time Management: Efficiently manage multiple PA requests and deadlines. Process-Oriented: Comfortable working in a structured environment with defined procedures. WHY INTELASSIST? We grow together. We value your effort. We aim to empower you. #J-18808-Ljbffr
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Prior Authorization Specialist
1 week ago
Quezon City, National Capital Region, Philippines 1840 & Company Full time ₱1,200,000 - ₱2,400,000 per yearWe are seeking a detail-oriented and experienced Prior Authorization Specialist to manage the full lifecycle of prior authorizations (PAs) for medical services. The ideal candidate will be responsible for timely submission, meticulous follow-up, and effective resolution of all prior authorization requests and subsequent appeals. This role is critical in...
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Certified Pharmacist
4 weeks ago
Quezon City, Philippines Intelassist Full timeEOR: One Workforce Global Employment Type: Full-Time Employment Work Setup: 100% Onsite (Office location in either Eastwood, Clark or Muntinlupa) Work Schedule: Night Shift (Following U.S. Central Time Zone) Duties and Responsibilities Intake and triage PA requests from providers, pharmacy, and patients; confirm eligibility and benefits. Gather required...
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Prior Authorization Specialist
2 weeks ago
Quezon City, National Capital Region, Philippines 1840&Company Full time ₱1,200,000 - ₱2,400,000 per yearWe are seeking a detail-oriented and experienced Prior Authorization Specialist to manage the full lifecycle of prior authorizations (PAs) for medical services. The ideal candidate will be responsible for timely submission, meticulous follow-up, and effective resolution of all prior authorization requests and subsequent appeals. This role is critical in...
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Prior Authorization Specialist
4 weeks ago
Batangas City, Philippines 1840 & Company Full timeWe are seeking a detail-oriented and experienced Prior Authorization Specialist to manage the full lifecycle of prior authorizations (PAs) for medical services. The ideal candidate will be responsible for timely submission, meticulous follow-up, and effective resolution of all prior authorization requests and subsequent appeals. This role is critical in...
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Prior Authorization Assistant
4 weeks ago
Cebu City, Philippines HirebizMed Full timeWere looking for a detail-oriented and experienced Prior Authorization Specialist to join our growing team. In this role, you will be responsible for handling pre-certifications, verifying insurance coverage, and ensuring timely approvals for medical procedures, medications, and services. Your work will directly support patients in accessing the care they...
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Prior Authorization
4 weeks ago
Quezon City, Philippines Swift-up Full timeResponsibilities: Submit requests for prior authorizations to insurance companies or third-party payers. Follow up on pending authorizations and ensure timely processing to prevent delays in patient care. Document authorization information in patient records and update as needed. Verify patients' insurance eligibility, benefits, and coverage limitations....
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Prior Authorization Specialist
2 weeks ago
Quezon City, National Capital Region, Philippines CF Outsourcing Solutions Full time ₱200,000 - ₱250,000 per yearJob Summary:Reporting to the Clinical Director and working closely with the Clinical Team, this role plays a key part in ensuring the financial health of the organization. The position serves as a vital link between patients with mental health and/or substance use disorders and insurance providers, healthcare services, and billing operations. It is essential...
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Pharmacist
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Quezon City, Philippines MEDEXPRESS PHARMACY Full timeOn-site position in Quezon City, no experience required, Bachelor's degree, full-time. Job Description The role involves providing medication management and patient counseling, ensuring compliance with pharmacy regulations and standards, reviewing and verifying prescription orders, collaborating with healthcare professionals to optimize patient care,...
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Utilization Review Nurse, USRN
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Pasig City, Philippines Visaya KPO Full timeRole Overview: We are seeking a skilled Utilization Management/Review Nurse to join our team. This role is essential in ensuring patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization. Key Responsibilities: Conduct concurrent and retrospective reviews of patient...
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HR Assistant
3 days ago
Quezon City, Philippines Doktors Generics Pharmacy Inc. Full timeAbout the role We are looking for an experienced HR Recruitment Specialist to join the talent acquisition team at Doktors Generics Pharmacy Inc'. As an HR Recruitment Specialist, you will play a crucial role in identifying, attracting and hiring top talent to support the growth and expansion of our organisation. This is a full-time position based in our...
