Medical Prior Authorization Specialist: Healthcare Navigator

1 month ago


Davao City, Davao, Philippines Med Supply US Full time
Job Summary:

We are seeking a skilled Medical Prior Authorization Specialist to join our team at Med Supply US. As a key member of our healthcare team, you will play a vital role in ensuring that medical services and procedures are approved by insurance companies.

Responsibilities:
  • Prior Authorization Management: Review and evaluate medical service requests to determine if prior authorization is required. Gather relevant medical documentation to support the authorization request.
  • Insurance Verification: Verify patient insurance coverage, including benefits, eligibility, and limitations. Obtain and document necessary insurance information for accurate billing and reimbursement.
  • Documentation and Communication: Prepare and submit prior authorization requests to insurance companies, adhering to their specific guidelines. Maintain accurate records of all authorization requests, follow-up activities, and outcomes.
  • Policy and Compliance: Stay up-to-date with insurance policies, guidelines, and industry regulations related to prior authorizations. Ensure compliance with 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.
Requirements:
  • Bachelor's degree in a related field or equivalent experience
  • Prior experience in healthcare administration, medical billing, or insurance coordination
  • Strong knowledge of medical terminology, CPT codes, ICD-10 codes, and insurance procedures
  • Excellent communication skills, both written and verbal
  • Attention to detail and ability to organize and prioritize tasks in a fast-paced environment
Salary:

$65,000 - $85,000 per year



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