Prior Authorization

2 weeks ago

Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱30,000 - ₱50,000 per year

Req ID:  1711

Connext is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for a Prior Authorization Specialist with Insurance Verification experience to work with Connext's Client in the United States of America.

What's in it for you? (Benefits and Sign-On Bonus)

  • Competitive compensation

  • Perfect Attendance Bonus

  • Life insurance

  • HMO Insurance

  • Great company culture

  • 25% Night Differential

  • Annual Increase

  • 5,000 Php Sign-On Bonus

What is the job? 

The Prior Authorization Specialist is responsible for conducting insurance verifications and obtaining prior authorizations for a diverse range of therapy services, including Physical Therapy, Occupational Therapy, Speech Therapy, Autism Therapy, and Outpatient Behavioral Health.

Responsibilities:


• Verify eligibility/benefits and referral/auth needs across payers, states, products, and specialties within SLAs

• Gather records from providers; communicate authorization decisions clearly

• Complete prior auths via portals/calls; follow up to secure timely approvals

• Handle multiple prior auths concurrently; establish processes to maintain top performance

• Serve as SME on prior-authorization workflows for major insurers; coordinate across stakeholders

• Protect PHI and maintain strict HIPAA compliance

Qualifications:


• Minimum of one (1) year experience with medical billing and/or understanding of benefits including deductibles, co-insurance, out of pocket and benefits exclusions.

• Familiar with providers software, including Electronic Medical Record Systems (EMR/EHR) and Practice Management Systems (PMS).

• Experience with HMOs, PPOs, POSs, EPOs, Medicare, Medicaid. Understanding of each through the referral and authorization process.

• Demonstrates strong understanding of insurance policies and medical billing processes including CPT coding.

• Phone etiquette and customer service skills, experience calling insurers to collect benefits and confirm authorization status.

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