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Prior Authorization Specialist

2 weeks ago

Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time $40,000 - $60,000 per year

Connext is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for a Prior Authorization Specialist who will be working with Connext's Client in the United States of America.

What's in it for you?

  • Competitive compensation
  • Perfect Attendance Bonus
  • Life insurance
  • HMO Insurance
  • Great company culture
  • 25% Night Differential
  • Annual Increase
  • 13th Month Pay
  • Mid-Year Bonus

What is the job?

The Prior Authorization Specialist is responsible for conducting insurance verifications and obtaining prior authorizations for a diverse range of therapy services, including Physical Therapy, Occupational Therapy, Speech Therapy, Autism Therapy, and Outpatient Behavioral Health.

Responsibilities

  • Verify patient eligibility, benefits, referrals, and authorization requirements across payers, states, and specialties within SLAs.
  • Collaborate with providers to collect accurate patient and medical records and relay authorization decisions.
  • Complete prior authorizations efficiently via insurance portals or direct calls with insurers.
  • Follow up with insurers to ensure timely approvals and provide additional documentation as needed.
  • Manage multiple prior authorizations simultaneously while optimizing processes for high performance.
  • Serve as a subject matter expert in prior authorization workflows, ensuring compliance with HIPAA and effective stakeholder communication.

Qualifications

  • Minimum one year of medical billing/benefits experience with a stable employment history.
  • Strong knowledge of insurance policies, medical billing processes, CPT coding, deductibles, co-insurance, out-of-pocket costs, and benefit exclusions.
  • Proficient with EMR/EHR systems, Practice Management Systems, and insurance portals.
  • Experienced with HMO, PPO, POS, EPO, Medicare, and Medicaid referral and authorization processes.