Xtn-2Ece992 | Clinical-Team Member

2 weeks ago

Taguig, National Capital Region, Philippines KMC Solutions Full time


Duties and 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.
Minimum competencies
  • 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
Minimum qualifications
  • Academic qualification for this role is a graduate in Nursing.
  • Required Certifications/Licensure: Registered Nurse currently licensed.
  • Familiarity with health compliances, such as
    Awareness and implementation of ISO, ISMS and GRIC policies
    Adherence to the rules and regulations as outlined by the management. 

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