Clinical Authorization Specialist

2 days ago

Taguig, National Capital Region, Philippines AGS health Full time ₱1,200,000 - ₱2,400,000 per year

Job Title: Clinical Authorization Specialist

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 cuttingedge 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:

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Responsibilities:

➢ 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

Compliance:

➢ Awareness and implementation of ISO, ISMS and GRIC policies.

➢ Adherence to the rules and regulations as outlined by the management.

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