Prior Authorization Specialist

2 weeks ago

Quezon City, National Capital Region, Philippines CF Outsourcing Solutions Full time ₱200,000 - ₱250,000 per year


Job Summary:

Reporting to the Clinical Director and working closely with the Clinical Team, this role plays a key part in ensuring the financial health of the organization. The position serves as a vital link between patients with mental health and/or substance use disorders and insurance providers, healthcare services, and billing operations. It is essential to the success of the companys programs.

Key Responsibilities:

Therapy/IOP Prior Authorizations (PARs):

    • Confirm insurance coverage
    • Monitor and track therapy sessions weekly
    • Coordinate with therapists to obtain necessary documentation
    • Prepare and submit PARs
    • Upload and organize submissions; maintain tracking sheets
    • Notify RMH Manager and therapists of authorization outcomes
    Residential Mental Health (RMH) PARs:
    • Verify insurance eligibility
    • Complete and submit RMH PARs
    • Upload and organize documentation
    • Communicate approval or denial status to RMH Manager and therapists
    Housing PARs (if applicable):
    • Monitor the housing PAR request tracker
    • Collaborate with therapists to write clinical snapshots
    • Ensure accuracy of the tracker
    • Inform the housing team of approved applicants

Qualifications:

  • Bachelor's degree required
  • With at least 1 year experience in Prior Authorization.
General Duties:
  • Respond promptly to emails and phone calls
  • Provide timely updates to third-party payers
  • Complete daily documentation
  • Submit Superbills within 24 hours of patient discharge
  • Attend all required meetings
  • Support the Clinical Director, RMH Manager, and Therapy Team as needed

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