Prior Authorization Experience

2 days ago

Manila, National Capital Region, Philippines Omega Healthcare Management Services Inc. Full time $40,000 - $60,000 per year

Job Purpose

A Precertification Coordinator is responsible for obtaining prior authorizations on behalf of the provider's office for imaging services and surgeries.

Job Duties and Responsibilities

  • Prioritize incoming authorization requests according to queue urgency

  • Review patient's clinical and chart documentation related to the service submitted by the provider's office

  • Obtain and/or follow up on authorization requests from the patient's payer/s through any of the following methods—depending on the payer's policy:

  • Perform outbound calls to payer's authorization department

  • Access payer's authorization online portal

  • Submit faxes to payer's authorization department

  • Respond to payer's clinical questions to be able to proceed with the authorization requests

  • Obtain and/or follow up payer's peer-to-peer review requirements and send them back to provider's office for the actual initiation

  • Cater inbound calls from payers and perform necessary actions required for the task

  • Listen and review voicemail messages from payers then perform necessary actions required for the task

Required Skills


• Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes


• Comprehensive understanding of Medical Terminology


• Prior experience in processing multispecialty authorizations including contact with payers


• Experience in medical coding for multiple specialties


• Experience with general computer software (Internet, Word, Outlook, PDF required)


• Proficiency to learn new software programs quickly


• Excellent customer service skills: communicates clearly and effectively


• Excellent verbal and written communication skills


• Professional and effective interaction skills with co-workers, clients, providers, and vendors


• Proven ability to work well individually and as a team member


• Strong attention to detail


• Ability to follow company and account-specific standard operating procedures and policies


• Ability to adapt to constantly changing environment


• Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand


• Ability to remain organized with multiple interruptions


• Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies


• Ability to comfortably receive constructive feedback

Required Experience

· Minimum of 1 year prior authorization experience in healthcare business process outsourcing

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