Medical Claims Examiner

2 weeks ago

Porac, Philippines beBeeAuthorization Full time ₱1,200,000 - ₱1,500,000
Job Overview

The Prior Authorization Specialist will be primarily responsible for obtaining all types of prior authorizations. These prior authorizations will include biologic medications, procedures, prescriptions and out-patient testing.

  • Review and process prior authorization requests for medical services, procedures, and medications
  • Verify insurance 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 EMR.
  • 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
Requirements and Qualifications

To be successful as a Prior Authorization Specialist, you will need:

  • A proven track record of 3-5 years of experience in the US Healthcare industry
  • 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, work-from-home setup
  • Amenable to work in a graveyard shift
System Requirements

To perform this role, you will need:

  • A device (Desktop or Laptop)
  1. Processor:
  • Windows Devices: Intel Core i5 (or higher) or AMD Ryzen 5 (or higher)
  • Mac Devices: Apple M1 chip or newer
RAM:
  • Minimum of 8GB or higher for optimal performance
Operating System:
  • Windows: Windows 11 Pro (Windows 10 Pro is acceptable but not preferred)
  • Mac: macOS compatible with M1 or newer chips
Hard Disk:
  • At least an SSD for faster processing and performance
Internet Connectivity:
  • Minimum speed of 50 Mbps via a wired connection for stability and reliability
  • A backup internet connection is highly recommended

  • Medical Claims Examiner

    2 weeks ago

    Porac, Philippines beBeeClaims Full time $50,000 - $70,000

    Job OverviewThe role of a Medical Claims Examiner is to oversee the examination of medical claims and manage denied or aging claims efficiently.This position involves reviewing and managing denied or aging claims, working claim queues to identify root causes of denials, and making outbound phone calls to insurance payers to check claim statuses and resolve...

  • Medical Claims Analyst

    2 weeks ago

    Porac, Philippines beBeemedical Full time ₱250,000 - ₱350,000

    Medical Billing SpecialistWe are seeking a detail-oriented Medical Billing Specialist to join our team. The ideal candidate will have strong organizational skills, exceptional accuracy in data entry, and experience in managing medical claims and insurance processes.

  • Medical Claims Specialist

    2 weeks ago

    Porac, Philippines beBeemedical Full time ₱250,000 - ₱350,000

    Job OverviewWe are seeking a highly skilled Medical Claims Specialist to join our team. The ideal candidate will possess excellent written and oral communication skills, attention to detail, and the ability to multitask.

  • Ophthalmology Optometry Medical Claims Specialist

    2 weeks ago

    Porac, Philippines beBeeRevenue Full time ₱800,000 - ₱1,200,000

    Job Title:Medical Claims SpecialistWe are seeking dedicated Medical Claims Specialists to work from home. The ideal candidate will have expertise in medical billing and coding, with a strong understanding of healthcare insurance plans and related policies.Responsibilities include managing accounts receivables, coordinating with healthcare providers and...

  • Medical Claims Recovery Specialist

    2 weeks ago

    Porac, Philippines beBeeBillingspecialist Full time $60,000 - $120,000

    Job OpportunityWe are seeking a detail-oriented professional to support our revenue cycle operations. This role is primarily focused on reducing claim denials and recovering aging or stale claims.Log into our billing system to review and manage denied or aging claims.Work claim queues to identify root causes of denials and submit appropriate documentation or...

  • Healthcare Claims Coordinator

    2 weeks ago

    Porac, Philippines beBeeAccountability Full time ₱372,000 - ₱473,000

    Medical Billing Specialist Job DescriptionWe are seeking a highly organized and detail-oriented Medical Billing Specialist to join our team. The ideal candidate will have experience in medical billing, accounts receivable, or claims management and be proficient in Prompt EMR and Microsoft Office Suite.Main Responsibilities:Prepare and submit medical claims...

  • High Volume Medical Claims Specialist

    2 weeks ago

    Porac, Philippines beBeeBiller Full time ₱45,000 - ₱55,000

    Job Summary:We are seeking a skilled Medical Biller to manage billing processes and secure payments from third-party payers. The ideal candidate will have strong communication, interpersonal, and organizational skills.Key Responsibilities:Coordinate with various departments to post charges to resident accounts.Review charges for accuracy and...

  • Healthcare Claims Processor

    2 weeks ago

    Porac, Philippines beBeeClaims Full time $9,600

    Medical Claims SpecialistThe role of a Medical Claims Specialist involves working in healthcare facilities, submitting claims to insurance companies, and ensuring accurate data entry. A strong foundation in US Healthcare Claims Customer Service is essential for this position.">Effective communication and attention to detail are crucial skills for success in...

  • Medication Verification Expert

    2 weeks ago

    Porac, Philippines beBeePharmacist Full time ₱400,000 - ₱600,000

    Virtual Medication SpecialistThis role involves the verification of medications packed into dose-ready sachets using AI-driven tools. The successful candidate will have experience in pharmacy operations, claims management, or clinical pharmacy and be proficient with technology, including AI tools and claims management systems.ResponsibilitiesVerify...

  • Efficient Healthcare Claims Processor

    2 weeks ago

    Porac, Philippines beBeeHealthcare Full time ₱300,000 - ₱480,000

    Medical Biller Job DescriptionWe are seeking a skilled Medical Biller to join our team. The successful candidate will be responsible for posting medical charges, payments, and journal entries to patient accounts in a timely and accurate manner.Main ResponsibilitiesWork directly with insurance companies, healthcare providers, and patients to process claims...