PHRN Prior Authorization Expert

3 days ago

Ortigas Metro Manila, Philippines Omega Healthcare Management Services Inc. Full time

Job Purpose

A Precertification Coordinator is responsible for obtaining prior authorizations and referrals on behalf of the provider's office for Cardiac Cath, Cardiac EP,for Outpatient and Inpatient  procedures,

Job Duties and Responsibilities

· Prioritize incoming authorization and referral 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 and referral requests from the patient's payer/s through any of the following methods—depending on the payer's policy:

o    Perform outbound calls to payer's authorization department

o    Access payer's authorization online portal

o    Submit faxes to payer's authorization department

· Respond to payer's clinical questions to be able to proceed with the authorization and referral 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 specially for Cardiac procedures

· 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

· Candidates must possess a bachelor's degree in one of the following:

o    Must be active license holder for PH-RN

· –2 years of experience in business process outsourcing

· Preferrably with minimum of 1-year experience in Prior authorization

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