Prior Authorization Specialist

2 days ago

Pasig, National Capital Region, Philippines People Matter PH Full time ₱450,000 - ₱600,000 per year

We are seeking a detail-oriented and efficient Prior Authorization Specialist with an active Philippine Registered Nurse (PHRN) license. The ideal candidate will have at least one year of prior authorization or healthcare BPO experience, with a solid understanding of insurance verification, pre-certification processes, and U.S. healthcare operations.

The Prior Authorization Specialist plays a vital role in ensuring that patients receive timely care by securing necessary approvals from insurance providers before medical services are rendered.

Key Responsibilities:

  • Review and process prior authorization requests for medical procedures, diagnostic tests, and medications.
  • Validate insurance coverage, medical necessity, and eligibility based on payer guidelines and policies.
  • Coordinate with physicians, healthcare providers, and insurance representatives to ensure timely completion of pre-certifications.
  • Document authorization approvals, denials, and pending requests accurately in the system.
  • Follow up on outstanding authorization requests and communicate status updates to relevant departments.
  • Ensure compliance with HIPAA and U.S. healthcare regulations.
  • Maintain performance and quality standards aligned with company and client expectations.

Qualifications:

  • Graduate of Bachelor of Science in Nursing (BSN)
  • Active Philippine Registered Nurse (PHRN) license
  • Minimum of 1 year experience in Prior Authorization, Utilization Review, or Healthcare BPO (U.S. Account preferred)
  • Strong communication skills (verbal and written), analytical thinking, and attention to detail
  • Proficient in MS Office and familiar with EMR/EHR or healthcare software systems
  • Availability: Willing to work on night shifts and U.S. time zones, as required

Job Type: Full-time

Pay: Up to Php50,000.00 per month

Benefits:

  • Company Christmas gift
  • Health insurance
  • Opportunities for promotion
  • Paid training

Experience:

  • Prior Authorization: 1 year (Preferred)
  • BPO Healthcare Account: 1 year (Preferred)

License/Certification:

  • PHRN License (Required)

Work Location: In person

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