PHRN with BPO Healthcare Experience

1 day ago

Pasig, National Capital Region, Philippines Omega Healthcare Management Services Inc. Full time $60,000 - $80,000 per year

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:
  • 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 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
  • 2 years experience of acute hospital experience
  • Experience in prior authorization process
  • 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

  • Graduate of Bachelor of Science in Nursing with active PH registered nurse license
  • 1–2 years of experience in healthcare business process outsourcing
  • 1-2 years of hospital/clinical experience

We are accepting walk in candidates from 11AM- 5PM weekdays.

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