Prior Authorization

2 days ago

Manila, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱600,000 - ₱800,000 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 an Prior Authorization 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

What is the job?

The Prior Authorization 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, and authorization requirements across multiple payers and specialties.
  • Coordinate with providers to collect medical records and relay authorization decisions.
  • Complete and submit prior authorizations through insurer portals or phone calls.
  • Follow up with insurers to ensure timely approval and provide additional details as needed.
  • Manage multiple authorizations simultaneously while maintaining high performance standards.
  • Adhere to HIPAA regulations and maintain confidentiality of all patient information.

Qualifications:

  • At least 1 year of experience in medical billing or understanding of insurance benefits, including deductibles and exclusions.
  • Proficient in EMR/EHR and Practice Management Systems (PMS).
  • Knowledgeable in various insurance types (HMO, PPO, POS, EPO, Medicare, Medicaid) and their referral/authorization processes.
  • Strong grasp of insurance policies, medical billing procedures, and CPT coding.
  • Skilled in navigating insurance portals and communicating with insurers to verify benefits.
  • Demonstrates professionalism, organization, and efficiency while working independently under deadlines.

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