Prior Authorization Coordinator

1 day ago


Calamba, Calabarzon, Philippines beBeeAuthorization Full time ₱400,000 - ₱600,000
Job Summary:

We are seeking a highly skilled Prior Authorization Specialist to join our organization.

The successful candidate will be responsible for obtaining all types of prior authorizations, including biologic medications, procedures, prescriptions, and out-patient testing.

This role requires strong professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies, and insurance carriers to accurately obtain the required information to process prior authorizations.

Main Responsibilities:
  • Review and process prior authorization requests for medical services, procedures, and medications
  • Verify insurance (pharmacy) information and eligibility
  • Handle patient inquiries regarding authorizations
  • Provide necessary prior authorization documentation to patients for completion and signature. Review all forms for completeness and accuracy.
  • Accurately document all patient, pharmacy, and insurance carrier interactions in an electronic medical record.
  • Coordinate with healthcare providers and insurance companies to obtain necessary authorizations
  • Ensure accurate and timely documentation of authorization requests and approvals
  • Collaborate with medical billing team to resolve any issues or denials
  • Maintain up-to-date knowledge of insurance guidelines and procedures
  • Complete other tasks as assigned by providers through an electronic medical record/EHR
  • Copy, fax, and mail documents and information as requested by insurance carrier
  • Schedule follow-up appointments, biologic injections, and photodynamic therapy treatments
  • Assist pathology department with notifying patients of pathology results via telephone

Requirements:

  • Proven 3-5 years of experience as a Prior Authorization Specialist in the US Healthcare
  • Strong knowledge of insurance verification processes and payer/billing guidelines.
  • Excellent communication and interpersonal skills to work effectively with patients, providers, and insurers.
  • Detail-oriented with strong organizational skills
  • Ability to work independently and meet deadlines
  • Comfortable working in a remote setup
  • Amenable to work in a graveyard shift
Requirements Overview:
  • Key Skills and Qualifications
  • Industry Expertise
  • Behavioral Traits and Soft Skills
  • Professional Certifications and Licenses


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