Authorization & Eligibility Specialist (Onsite)

4 weeks ago

Davao City, Davao, Philippines Snapscale Full time
Overview

Snapscale is looking for an expert Authorization and Eligibility Specialist to perform the following functions:

  • Verify insurance eligibility, benefits, exclusions, deductibles, co-pays, and co-insurance for occupational and speech therapy patients.
  • Contact insurance providers to clarify discrepancies or misquoted benefits.
  • Enter benefit details into forms and calculate patient responsibility (worst- and best-case coverage scenarios).
  • Complete good-faith estimates.
  • Check, submit, and track therapy authorization requirements.
  • Ensure all services have valid authorizations to prevent denials.
  • Upload and process data from E-Bridge Software; maintain accurate and updated EMR records.
  • Review medical records to confirm authorization and eligibility accuracy.
  • Use medical terminology and coding knowledge for eligibility and authorizations.
  • Re-verify insurance coverage based on denial codes.
  • Protect patient confidentiality and comply with HIPAA regulations.
  • Work with providers and staff to resolve authorization and billing issues.
  • Perform follow-up tasks related to billing as directed by the Senior Medical Billing & RCM Manager.
Qualifications
  • 5+ years of experience handling insurance authorizations, eligibility, and benefits verification for OT, PT, and SLP clinics (pediatrics preferred)
  • Proficient in insurance portals, calling insurers, and EMR data entry
  • Ideal candidate has experience with Fusion Web Clinic EMR (Therapy Brands)
  • Background in private practice settings preferred
  • Strong medical terminology, anatomy, and insurance billing knowledge
  • Detail-oriented, hardworking, and diligent
  • Tech-savvy and quick to learn new EMR systems
  • Accurate in coding and billing with strong understanding of reimbursement processes
  • Clear communicator; able to work effectively with providers, insurers, and patients
  • Highly reliable and responsive

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