Prior Authorization Specialist

5 days ago


Manila, National Capital Region, Philippines Connext Full time

Connext Global Solutions is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for a Prior Authorization Specialist who will be working with Connext's Client in the United States of America.

What's in it for you?

  • Competitive compensation
  • Perfect Attendance Bonus
  • Life insurance
  • HMO Insurance
  • Great company culture
  • Annual Merit Increase
  • 25% Night Differential
  • Php 10,000 Sign-On Bonus

What is the job?

The Prior Authorization Specialist is responsible for conducting insurance verifications and obtaining prior authorizations for a diverse range of therapy services, including Physical Therapy, Occupational Therapy, Speech Therapy, Autism Therapy, and Outpatient Behavioral Health. This role requires a knowledgeable, organized, and professional individual with excellent communication skills to ensure timely processing and compliance with insurance requirements.

Screening Criteria:

  • Work Set-up: ONSITE (Ortigas)
  • Minimum of one (1) year of experience with medical billing and/or understanding of benefits including deductibles, co-insurance, out of pocket and benefits exclusions.
  • Must have a stable employment history.
  • Strong understanding of insurance policies and medical billing processes including CPT coding.
  • Familiar with provider software, including Electronic Medical Record Systems (EMR/EHR) and Practice Management Systems (PMS).
  • Experienced with HMOs, PPOs, POSs, EPOs, Medicare, Medicaid, and understanding of each through the referral and authorization process.

Responsibilities:

  • Verify patient eligibility and benefits via portal and/or phone call, including collecting referral and authorization requirements, across multiple payers, states, insurance products, and specialties within customer SLAs.
  • Work closely with providers to collect accurate patient and medical records and communicate authorization decisions.
  • Expeditiously complete prior authorizations using insurance portals or by calling insurers directly.
  • Ensure authorization is approved in a timely manner by following up with insurers and providing additional information.
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