Team Lead Pharmacy Authorization

3 days ago

Taguig, National Capital Region, Philippines AGS health Full time ₱2,000,000 - ₱2,500,000 per year

Job Title: Team Leader Pharmacy Authorization (RN)

Location: McKinley, Taguig City

Work Set-up: Onsite

OUR COMPANY

AGS Health is more than a revenue cycle management company–we're a strategic partner for growth. With expert services complemented by AI-enabled technologies and high-touch support, AGS Health is the premier revenue cycle partner for leading health systems, physician groups, and academic medical centers in the U.S. With expert insight into modern revenue cycle practices, the company pairs cutting-edge technology with college-educated, trained RCM experts to help clients optimize workflows, maintain compliance, prevent revenue leakage, and achieve a high-performance revenue cycle. AGS Health employs more than 12,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.

For more details, please visit

RESPONSIBILITIES

Team Management

  • Provide the team with the company's vision and the objectives of all processes.
  • Have excellent people management skills to ensure adequate production and quality SLAs (service level agreements) are met
  • Provide adequate training and knowledge sharing to the team by conducting daily and weekly meetings which are documented and acknowledged by the team
  • Monitoring daily production output and validating the same by means of timesheet approvals
  • Monitoring daily quality reviews of the quality audit team to ensure feedback is provided to the team and identified areas of concern are reviewed and completed in a timely manner
  • Monitoring and adhering to the company policies regarding leave and absenteeism within the team
  • Provide monthly performance report to the team on production & quality achievements and their areas for improvement
  • Serve as a SPOC (single point of contact) to communicate and resolve interface and integration issues with other teams
  • Adequate staffing is allocated within the various processes that need to be reported back to the client
  • Control Talent Retention to the minimum – attrition

Process Handling

  • Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements.
  • Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
  • Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
  • Prioritize the incoming authorizations by level of urgency to the patient.
  • Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
  • Respond to clinical questions regarding payer medical policy guidelines.

COMPETENCIES, SKILLS AND OTHER REQUISITES

  • Excellent written and spoken English
  • Unflinching integrity and personal work ethics
  • Self-starter who strives for self and team excellence
  • Flair for client satisfaction
  • Attention to detail and concern for accuracy
  • Excellent time management skills and multi-tasking ability
  • Excellent team player
  • Compliant to rules and regulations

ACADEMIC AND PROFESSIONAL BACKGROUND

  • Academic qualification for this role is a graduate in Nursing.
  • Required Certifications/Licensure: Registered Nurse currently licensed.

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