Medical Prior Authorization

2 months ago

Davao City, Philippines Med Supply US Full time
Position Summary:
The Prior Authorization Specialist plays a crucial role in the healthcare industry by ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they are rendered or prescribed. They work closely with healthcare providers, insurance companies, and patients to gather and submit the necessary information to obtain prior authorizations. The primary objective of a Prior Authorization Specialist is to navigate the complex process of securing pre-approval for healthcare services, minimizing delays in treatment and optimizing reimbursement.

Key Responsibilities:
  • Prior Authorization Management: Review and evaluate medical service requests, including procedures, tests, surgeries, and medications, to determine if prior authorization is required. Gather all relevant medical documentation, such as medical records, test results, and clinical notes, to support the authorization request.
  • Insurance Verification: Verify patient insurance coverage, including benefits, eligibility, and limitations. Obtain and document necessary insurance information to ensure accurate billing and reimbursement.
  • Documentation and Communication: Prepare and submit prior authorization requests to insurance companies or third-party payers, adhering to their specific guidelines and requirements. Maintain accurate and organized records of all authorization requests, follow-up activities, and outcomes. Communicate with healthcare providers, insurance companies, and patients to obtain additional information, clarify requirements, and provide updates on the status of authorizations.
  • Policy and Compliance: Stay up-to-date with insurance policies, guidelines, and industry regulations related to prior authorizations. Ensure compliance with all legal and regulatory requirements, including patient privacy and confidentiality (HIPAA).
  • Appeals and Denials: Assist with appeals and denials related to prior authorizations, working closely with healthcare providers and insurance companies to gather necessary information and submit appeals within specified timelines. Analyze denials and identify trends or areas for improvement to minimize future denials.
  • Quality Assurance: Perform periodic audits of prior authorization processes to identify any gaps or inefficiencies. Collaborate with team members and stakeholders to implement process improvements and enhance overall efficiency and accuracy.
  • Team Collaboration: Collaborate effectively with healthcare providers, nurses, medical assistants, billing staff, and other members of the healthcare team to ensure a smooth and coordinated workflow. Share knowledge, provide training, and offer guidance on prior authorization processes and best practices.

Qualifications and Skills:
  • High school diploma or equivalent. (some positions may require an associate's or bachelor's degree in a related field).
  • Prior experience in healthcare administration, medical billing, or insurance coordination is highly preferred.
  • Strong knowledge of medical terminology, CPT codes, ICD-10 codes, and insurance procedures.
  • Familiarity with insurance plans, prior authorization requirements, and reimbursement processes.
  • Excellent communication skills, both written and verbal, with the ability to effectively interact with healthcare professionals, insurance companies, and patients.
  • Attention to detail and ability to organize and prioritize tasks in a fast-paced environment.
  • Strong analytical and problem-solving skills, with the ability to navigate complex insurance processes and resolve issues efficiently.
  • Proficiency in using electronic health records (EHR) systems, billing software, and other relevant computer applications.
  • Note: The above job description provides a general overview of the responsibilities and requirements for a Prior Authorization Specialist. Actual job duties may vary depending on the specific healthcare setting, organizational policies, and regional regulations.
  • Prior Authorization experience required.

  • Training Specialist

    4 weeks ago

    Davao City, Philippines Med Supply US Full time

    Company Overview: Med Supply US is a leading provider of durable medical equipment, specializing in continuous glucose monitors and catheters. We are dedicated to enhancing the quality of life for patients with chronic medical conditions by offering top-tier products and exceptional service. Our commitment to excellence is reflected in our team members, who...

  • Trainer

    2 months ago

    Davao City, Philippines Med Supply US Full time

    About the Job:Med Supply US is one of the nation's leading home medical supply companies with years of experience serving patients with complex medical needs. We offer a full scope of Continuous Glucose Monitors (CGMs) and other diabetes products and services. We have built a collaborative culture that has allowed us to hire the best and deliver a...

  • Medical Billing Team Leader

    3 months ago

    Pasig City, Philippines Visaya Knowledge Process Outsourcing Corp Full time

    Duties & Responsibilities Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers Update patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claims Monitor claims for missing information, authorization, and control...

  • Medical Billing Team Leader

    3 months ago

    Pasig City, Philippines Visaya Knowledge Process Outsourcing Corp Full time

    Duties & Responsibilities Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers Update patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claims Monitor claims for missing information, authorization, and control...

  • Admin Medical Assistant

    4 months ago

    Pasig City, Philippines Manpower Core Group Inc. Full time

    Job Responsibilities • PARS for medications and procedures • Referral coordination to specialist • Record requests from hospitals or specialist • Give instructions to patients as instructed by Nurse Practitioner • Ensure all related reports, labs and information are filed and available in patients' medical records prior to their appointment •...

  • Admin Medical Assistant

    4 months ago

    Pasig City, Philippines Manpower Core Group Inc. Full time

    Job Responsibilities • PARS for medications and procedures • Referral coordination to specialist • Record requests from hospitals or specialist • Give instructions to patients as instructed by Nurse Practitioner • Ensure all related reports, labs and information are filed and available in patients' medical records prior to their appointment •...

  • Bio Medical Technician

    2 weeks ago

    ANGELES CITY, Philippines PRI MEDICAL CENTER Full time

    Under direction, supervises plans and directs the efficient operation and maintenance of hospital equipment, installation, and lighting. · Machinery, maintenance, and repair of the building and other hospital facilities, prepares and recommends plant layouts, plans, and specifications for repairs and expansion of the hospital. · Supervises all personnel...

  • BPO Medical Assistant

    4 months ago

    Pasig City, Philippines Manpower Core Group Inc. Full time

    With over 7,000 professionals across 9 delivery centers in the Philippines, we remains the country’s largest offshoring solutions provider. Medical Assistant, be 100% YOU! A Medical Assistant is expected to: Accompany/assist the medical provider(s) throughout their patient encounters. Record the history of the present illness, review of...

  • Bio Medical Technician

    2 weeks ago

    ANGELES CITY, Philippines PRI MEDICAL CENTER Full time

    Under direction, supervises plans and directs the efficient operation and maintenance of hospital equipment, installation, and lighting. · Machinery, maintenance, and repair of the building and other hospital facilities, prepares and recommends plant layouts, plans, and specifications for repairs and expansion of the hospital. · Supervises all personnel...

  • Medical Receptionist

    4 months ago

    Pasig City, Philippines Manpower Core Group Inc. Full time

    Medical Receptionist (Nurse) | Night Shift | Ortigas Center With over 7,000 professionals across 9 delivery centers in the Philippines, we remains the country’s largest offshoring solutions provider. Medical Receptionist, be 100% YOU! A Medical Receptionist is expected to perform the following tasks: Patients call our surgery clinic mainly to get an...

  • BPO Medical Assistant

    4 months ago

    Pasig City, Philippines Manpower Core Group Inc. Full time

    With over 7,000 professionals across 9 delivery centers in the Philippines, we remains the country’s largest offshoring solutions provider. Medical Assistant, be 100% YOU! A Medical Assistant is expected to: Accompany/assist the medical provider(s) throughout their patient encounters. Record the history of the present illness, review of systems,...

  • Healthcare Intake Specialist

    4 months ago

    Davao City, Philippines Med Supply US Full time

    About the Job:Med Supply US is a medical supply company that provides diabetic supplies to patients and doctors offices. We are looking for a full-time Intake Specialist to join our team.Position Overview:As a Healthcare Intake Specialist, you will play a crucial role in facilitating the intake process for patients seeking medical services. You will be...

  • Pre-Hospital Registered Nurse

    2 months ago

    Ortigas City, Philippines Hunter's Hub Incorporated Full time

    Provide support to the clinical team and client team. Determine customer eligibility by reviewing contractual language and medical documentation. Assess medical appropriateness of claims submitted, and adjust claims as needed. Pay all covered claims accurately and timely. Manage both new claims and open claims equally and maintains decision turnaround...

  • Medical Receptionist

    4 months ago

    Pasig City, Philippines Manpower Core Group Inc. Full time

    Medical Receptionist (Nurse) | Night Shift | Ortigas Center With over 7,000 professionals across 9 delivery centers in the Philippines, we remains the country’s largest offshoring solutions provider. Medical Receptionist, be 100% YOU! A Medical Receptionist is expected to perform the following tasks: Patients call our surgery clinic mainly to get an...

  • Inpatient Medical Coder

    2 months ago

    Cebu City, Philippines Cobden&Carter Full time

    PHRN + CIC/CCS + 2 Years IP DRG Experience | DRGV AUDITORLocation: Ortigas (Onsite) / Cebu / QCQualifications:Nursing degree mandatoryRegistered Nurse with CIC/CCS certification and prior auditing/DRG experience preferredExperience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferredPossesses knowledge of...

  • Medical Biller

    1 week ago

    Quezon City, Philippines Ruby Staffing Full time ₱38,000 - ₱40,000

    Work with us in the Philippines.We are looking for experienced Medical Billing Specialists who can work from Monday to Friday, to work from our BPO site. Candidates must have experience with Billing and Cash Posting to be considered.Main responsibilities include:Collect and review referrals and pre-authorizations.Follow-up on missed payments and resolve...

  • Pre-Hospital Registered Nurse

    2 months ago

    Ortigas City, Philippines Hunter's Hub Incorporated Full time

    Provide support to the clinical team and client team. Determine customer eligibility by reviewing contractual language and medical documentation. Assess medical appropriateness of claims submitted, and adjust claims as needed. Pay all covered claims accurately and timely. Manage both new claims and open claims equally and maintains decision turnaround...

  • Medical Biller

    1 week ago

    Quezon City, Philippines Ruby Staffing Full time ₱38,000 - ₱40,000

    Work with us in the Philippines.We are looking for experienced Medical Billing Specialists who can work from Monday to Friday, to work from our BPO site. Candidates must have experience with Billing and Cash Posting to be considered.Main responsibilities include:Collect and review referrals and pre-authorizations.Follow-up on missed payments and resolve...

  • Medical Representative/Professional Medical Representative

    3 weeks ago

    Quezon City, Philippines ZUNECA INCORPORATED Full time

    JOB REQUIREMENTS• Candidate must possess at least a Bachelor's Degree, Marketing, Pharmacy/Pharmacology, Nursing or equivalent.• At least 2-3 year(s) of working experience in Pharma sales is required for this position.• Experience in handling Ophtha or any products is a plus• Good communication skillsJOB RESPONSIBILITIES• Ensure that sales...

  • Medical Representative/Professional Medical Representative

    3 weeks ago

    Quezon City, Philippines ZUNECA INCORPORATED Full time

    JOB REQUIREMENTS • Candidate must possess at least a Bachelor's Degree, Marketing, Pharmacy/Pharmacology, Nursing or equivalent. • At least 2-3 year(s) of working experience in Pharma sales is required for this position. • Experience in handling Ophtha or any products is a plus • Good communication skills JOB RESPONSIBILITIES • Ensure...