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Prior Authorization Specialist

1 week ago

Manila, National Capital Region, Philippines Omega Healthcare Management Services Inc. Full time
Job Description

The Prior Authorization Experience role at Omega Healthcare Management Services Inc. involves obtaining prior authorizations on behalf of the provider's office for imaging services and surgeries.

  • Prioritize incoming authorization requests according to queue urgency, ensuring timely completion and minimizing delays.
  • Review patient clinical and chart documentation related to the service submitted by the provider's office, maintaining accuracy and attention to detail.
  • Obtain and/or follow up on authorization requests from the patient's payer through various methods:
    • Perform outbound calls to the payer's authorization department.
    • Access the payer's authorization online portal.
    • Submit faxes to the payer's authorization department.
  • Respond to payer clinical questions to proceed with authorization requests, fostering effective communication.
  • Obtain and/or follow up on payer peer-to-peer review requirements and send them back to the provider's office for initiation.
  • Cater to inbound calls from payers and perform necessary actions required for the task, ensuring seamless execution.
  • Listen and review voicemail messages from payers then perform necessary actions required for the task.
Required Skills and Qualifications

To excel in this role, you must possess:

  • A solid understanding of anatomy and physiology, including body systems function and disease processes.
  • A comprehensive understanding of Medical Terminology.
  • Prior experience in processing multispecialty authorizations, including contact with payers.
  • Experience in medical coding for multiple specialties.
  • Proficiency in general computer software, including Internet, Word, Outlook, and PDF.
  • The ability to learn new software programs quickly.
  • Excellent customer service skills, communicating clearly and effectively.
  • Excellent verbal and written communication skills.
  • Professional interaction skills with coworkers, clients, providers, and vendors.
  • The ability to work well individually and as a team member.
  • A strong attention to detail.
  • The ability to follow company and account-specific standard operating procedures and policies.
  • The ability to adapt to a constantly changing environment.
  • The ability to prioritize and organize multiple tasks while remaining focused and quality-driven.
  • The ability to remain organized with multiple interruptions.
  • The ability to make decisions independently without bypassing procedures and policies.
  • The ability to comfortably receive constructive feedback.