Eligibility and Authorizations Coordinator

2 weeks ago

Cagayan de Oro, Northern Mindanao, Philippines Clinovation Corp. Full time

We are seeking a detail-oriented and proactive Prior Authorization Coordinator to join our growing team. In this role, you will play a crucial part in ensuring timely access to care by managing insurance prior authorization processes for medical procedures, imaging, medications, and specialty services. You'll collaborate closely with healthcare providers, insurance payers, and patients to streamline approvals, prevent delays, and maintain accurate records.

Key Responsibilities:

  • Review and process prior authorization requests for various medical services, procedures, and medications.
  • Verify patient insurance benefits and eligibility before submitting authorization requests.
  • Communicate with healthcare providers to gather required clinical documentation and justification.
  • Submit and track authorization requests via insurance payer portals, fax, or phone as needed.
  • Follow up proactively with insurance companies on pending, delayed, or denied authorizations.
  • Document all actions, communications, and outcomes in the appropriate systems accurately and promptly.
  • Respond to inquiries from providers, payers, and internal departments regarding authorization statuses.
  • Ensure all processes comply with HIPAA, payer regulations, and internal quality standards.
  • Meet daily, weekly, and monthly productivity and quality performance metrics.

Qualifications:

  • Experience: Minimum 1 year of prior authorization, insurance verification experience in a US healthcare or BPO healthcare account.
  • Knowledge: Familiarity with insurance payer guidelines, prior authorization requirements, and healthcare terminology.

  • Skills:

    • Strong verbal and written English communication skills
    • Excellent attention to detail, accuracy, and organizational skills
    • Ability to multitask and manage time effectively in a fast-paced environment
    • Proficiency with insurance payer portals, EMR/EHR systems, and Microsoft Office tools (Word, Outlook, Excel, PDF)
What We Offer:
  • Permanent work-from-home setup
  • Competitive salary (with full government benefits — SSS, Pag-IBIG, and PhilHealth 100% covered. Zero salary deductions.)
  • Paid Time Off
  • Opportunities for career growth within a growing healthcare support services

    company
  • Weekends Off

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