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Medical Authorization Specialist

1 week ago

Manila, National Capital Region, Philippines Med-Metrix Full time

At Med-Metrix, we offer a unique opportunity to work with our dynamic team and make a meaningful impact in the healthcare industry.

Job Overview

This role is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies.

The ideal candidate will have extensive knowledge of individual payor websites, including EviCore, Navinet, and Novitasphere.

  • We are looking for a highly organized and detail-oriented individual who can prioritize tasks effectively.
  • The ability to communicate effectively with physician offices and patients is essential.
  • A minimum of 2-3 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations is required.

Maintaining confidentiality at all times and adhering to the policies and procedures established for the client/team are crucial aspects of this role.

Key Responsibilities
  • Works effectively with insurance companies to obtain pre-certification for services.
  • Places calls to various health plans to obtain appropriate precertification prior to the patient's appointment.
  • Faxes the pre-certification request form to the insurance company.
  • Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures.
  • Reviews claim denials and rejections.
  • Patient intake; insurance verification, notification of copays/patient liability, and confirmation of demographics.

This role offers opportunities for professional growth and development within our organization.