Prior Authorization Representative

5 days ago


Manila, National Capital Region, Philippines MED-METRIX INTERNATIONAL PH-I, INC. Full time

Experience these Xtraordinary benefits when you join Med-Metrix

  • 8-Hour Shifts, Fixed Weekends Off
  • Day 1 HMO with 2 of your dependents covered for FREE
  • Medical Cash Allowance
  • Rice Allowance
  • Clothing Allowance
  • Free Lunch Daily
  • Paid Time Off
  • Training and Staff Development
  • Employee Engagement Activities
  • Opportunities for Internal Mobility

The Prior Authorization Representative is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies.

Duties and Responsibilities

  • Works effectively with insurance companies to obtain pre-certification/authorization for services.
  • Places calls to various health plans to obtain appropriate precertification prior to the patient's appointment.
  • Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company.
  • Faxes pre-certification request forms to insurance companies.
  • Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures.
  • Verifies medical insurance information and documents in scheduling/registration modules.
  • Reviews claim denials and rejections.
  • Accurately enters and updates patient data, and other general data, into the computer system.
  • Patient intake; insurance verification, notification of copays/patient liability, and confirmation of demographics.
  • Maintains account work progress, including updating authorization logs, account referral in EMR, authorization paperwork, and issue reports.
  • Demonstrates knowledge of varied managed care insurance and regulatory guidelines.
  • Meets and maintains daily productivity/quality standards established in departmental policies.
  • Uses the MPower workflow system, client host system, and other tools to collect payments and resolve accounts.
  • Adheres to the policies and procedures established for the client/team.
  • Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Communicates effectively with physician offices and patients.
  • Places outbound calls to patients with precertification notifications.
  • Works independently from assigned work queues.
  • Maintains confidentiality at all times.
  • Maintains a professional attitude.
  • Other duties as assigned by the management team.

Qualifications

  • Must have completed at least 1 year in College under a medical-allied course.
  • Medical terminology knowledge, required.
  • Minimum of 2 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations.
  • Extensive knowledge of individual payor websites, including eviCore, Navinet, and Novitasphere.
  • Knowledge of Medical Terminology, CPT Codes, Modifiers, and Diagnosis Codes.
  • Ability to work well individually and in a team environment.
  • Strong organizational and task prioritization skills.
  • Proficiency with MS Office; must have basic Excel skillset.
  • Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred.
  • Strong communication skills (oral and written).
  • Strong organizational skills.
  • Must be amenable to work during US hours.
  • Must be amenable to work onsite.
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