Prior Authorization Specialist 2

4 days ago

Davao City, Davao, Philippines Connext Full time $40,000 - $60,000 per year

The Prior Authorization Specialist will manage the authorization process for injectable medications. This role involves obtaining prior authorizations from insurance companies, coordinating with healthcare providers, and ordering injectable medications from drug manufacturers. The ideal candidate will have experience in medical billing, insurance verification, and knowledge of specialty pharmaceuticals.

Job Description


• Submit and track prior authorization requests for injectable medications.

• Verify patients' insurance benefits, coverage, and eligibility.

• Appeal denied claims and ensured timely resolution of authorization issues.

• Work closely with physicians, nurses, and pharmacy staff to ensure proper documentation.

• Communicate with patients regarding authorization status and copay assistance programs.

• Serve as a liaison between healthcare providers, drug manufacturers, and insurance companies.

• Place orders for injectable medications directly from drug manufacturers and specialty pharmacies.

• Ensure medications are delivered in a timely manner and monitor inventory as needed.

• Maintain accurate records of medication orders and track shipments.

• Ensure compliance with HIPAA, insurance guidelines, and billing regulations.

• Maintain thorough and organized records of prior authorizations and patient interactions.

• Stay updated on insurance policies, formularies, and reimbursement guidelines.

Required Qualifications


• Familiarity with injectable medications, specialty drugs, and insurance coverage policies.

• Knowledge of EMR/EHR systems and prior authorization portals.

• Strong attention to detail and ability to multitask in a fast-paced environment.

• Clear and coherent in both written and verbal communication skills.

• Effective problem-solving skills.

• Proficiency in Microsoft Office and healthcare software.

• Open to others' ideas, provides and accepts feedback, and works well with the team to reach goals.

• Respects and values cultural differences and helps create a respectful, inclusive environment.

• Treats others with respect, keeps promises, and acts with honesty and integrity.

• Follows company policies and procedures.

• Remains calm under pressure, treats others respectfully, takes responsibility, and follows through on commitments.

• Follows safety rules and reports any potential hazards.

• Arrives on time and ensures work is covered when absent.

• Follows instructions and responds well to management direction.

Screening Criteria

• Minimum of three (3) years in Insurance Prior Authorization for injectable medications.

• Must have stable employment history.

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