Medical Service Pre-Authorization Specialist

6 days ago

Manila, National Capital Region, Philippines beBeeAuthorization Full time ₱600,000 - ₱800,000
Prior Authorization Coordinator

We are seeking an experienced professional to join our organization in the role of Prior Authorization Coordinator.

The ideal candidate will be responsible for obtaining all types of prior authorizations, including biologic medications, procedures, prescriptions, and out-patient testing. This requires professional and courteous interaction with patients, pharmaceutical representatives, providers, pharmacies, and insurance carriers to accurately obtain the required information to process prior authorizations.

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 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
  • Maintain up-to-date knowledge of insurance guidelines and procedures
  • Complete other tasks as assigned by providers through EMR/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
  • Support organizational responsibilities as assigned, which may include but are not limited to: respecting and promoting patient's rights, responding appropriately to emergency situations, sharing problems relating to patients and/or staff with Care Center Leader in a timely manner
  • Provide safe patient-centered, compassionate, and competent patient care.
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, work-from-home setup
    • Able to work flexible hours, including evenings and weekends

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