Prior Authorization Specialist

3 days ago

Eastwood Quezon City PH Intelassist Full time ₱900,000 - ₱1,200,000 per year

Work Setup: 100% Onsite
Location: 19th Floor, CyberOne, Eastwood Ave, Bagumbayan, Quezon City, 1800 Metro Manila
Shift: Graveyard/Nightshift

Job Summary:

We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team in Eastwood City. The ideal candidate will have a strong background in NextGen EHR or similar practice management systems and procedures. This role is responsible for ensuring timely and accurate insurance authorizations for services and procedures, working closely with providers, patients, and payers to prevent delays in patient care.

Duties and Responsibilities:

  • Obtain prior authorizations for procedures, diagnostic imaging, medications, and other services specific to pain management.
  • Utilize NextGen EHR to initiate, track, and document all authorization requests.
  • Review patient charts and clinical documentation to ensure medical necessity requirements are met.
  • Communicate with insurance companies and third-party payers to secure authorizations and resolve denials or delays.
  • Coordinate with physicians and clinical teams to obtain additional documentation or clarification as needed.
  • Maintain accurate records of authorizations, including expiration dates and approval numbers, within the patient chart.
  • Follow up proactively on pending authorizations and escalate as needed to avoid appointment or treatment delays.
  • Stay updated on payer-specific guidelines and pain management treatment policies.
  • Collaborate with billing and coding teams to ensure seamless reimbursement processes.

Job Requirements:

  • College graduate a or equivalent required; additional education or certification (e.g., CMA, CPAR) is a plus.
  • Minimum 4 years of experience in prior authorization or insurance verification roles, preferably in pain management or a similar specialty.
  • Proficiency in NextGen EHR or similar practice management systems is a plus.
  • Strong knowledge of insurance guidelines, medical terminology, and CPT/ICD coding relevant to pain management.
  • Excellent communication and organizational skills.
  • Ability to work independently and manage multiple priorities with accuracy and efficiency.

Preferred Attributes:

  • Familiarity with commonly prescribed medications and procedures in pain management (e.g., epidural injections, nerve blocks, spinal cord stimulators).
  • Experience working with Medicare, Medicaid, and commercial insurance payers.
  • Prior experience handling urgent authorization requests and appeals.

WHY INTELASSIST?
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