Prior Authorization Specialist with 25 Night Differential

7 hours ago

Davao City, Davao, Philippines Connext Full time ₱150,000 - ₱250,000 per year

Job Summary

The Authorization Specialist is responsible for managing the authorizations and referrals for medical services. This role involves reviewing the medical history of potential patients, verifying information from referring physicians, ensuring insurance coverage, and monitoring the schedule for add-on patients. The Authorization Specialist ensures all necessary authorizations are in place for appointments or procedures to proceed smoothly.

Responsibilities


• Complete authorizations and referrals for medical services, including appointments and procedures.


• Review patients' medical histories to ensure accurate and complete information.


• Contact insurance companies to verify coverage and obtain necessary approvals.


• Contact referring physicians to gather additional information or clarify details as needed.


• Monitor the schedule for add-on patients to identify and resolve potential conflicts.


• Ensure all prior authorizations are obtained before appointments or procedures.


• Input new patient information into the system and update existing records.


• Maintain accurate and up-to-date records of all authorizations and referrals.


• Complete and process billing documentation related to authorizations and referrals.


• Assist with the preparation and submission of insurance claims as needed.


• Perform other clerical tasks as required to support the administrative functions of the department.

Qualifications and Requirements


• Knowledgeable with medical terms used in patient records and insurance documentation.


• Familiarity with different types of insurance plans, coverage details, and authorization requirements.


• Proficiency in navigating and updating patient records digitally, ensuring accuracy and confidentiality.


• Strong organizational and time-management abilities with the ability to manage multiple tasks, prioritize workload, and meet deadlines.


• Clear and coherent in both written and verbal communication skills to effectively convey information to patients, healthcare providers, and insurance representatives.


• Basic knowledge of Microsoft Office Suite for documentation, data analysis, and communication.


• Meticulous attention to detail with the ability to identify discrepancies in records, resolve billing issues, and ensure all information is accurate.


•Ability to adhere to industry standards and best practices in billing and authorization processes.

Screening Criteria


• High school diploma or an equivalent combination of education and related work experience.


• At least one (1) to two (2) years of experience in medical billing, insurance authorization, or a related field.


• Must have a stable employment history.

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