Prior Authorization Representative

3 days ago

Manila, National Capital Region, Philippines MED-METRIX INTERNATIONAL PH-I, INC. Full time

Experience these exceptional benefits when you join Med-Metrix

  • 8-Hour Shifts, Fixed Weekends Off
  • Day 1 HMO with 2 of your dependents covered for FREE
  • Group Life Insurance
  • Medical Cash Allowance
  • Rice Allowance
  • Clothing Allowance
  • Holiday Gift
  • Bereavement Assistance
  • Free Lunch Daily
  • Paid Time Off
  • Training and Staff Development
  • Employee Engagement Activities
  • Opportunities for Internal Mobility

The Prior Authorization Representative is responsible for obtaining and providing accurate and complete data input for precertification/preauthorization from insurance companies

Duties and Responsibilities

  • Works effectively with insurance companies to obtain pre-certification/ authorization for services
  • Places calls to various health plans to obtain appropriate precertification prior to the patient`s appointment
  • Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
  • Faxes to pre-certification request form to insurance company
  • Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures
  • Verifies medical insurance information and documents in scheduling/registration modules
  • Reviews claim denials and rejections
  • Accurately enters and updates patient data, and other general data, into the computer system
  • Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics
  • Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
  • Demonstrates knowledge of varied managed care insurance and regulatory guidelines
  • Meets and maintains daily productivity/quality standards established in departmental policies
  • Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts
  • Adheres to the policies and procedures established for the client/team
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Communicate effectively with physician offices and patients.
  • Place outbound call to patients with precertification notification.
  • Work independently from assigned work queues
  • Maintain confidentiality at all times
  • Maintain a professional attitude
  • Other duties as assigned by the management team

Qualifications

  • Must have completed at least 1 year in College under a medical-allied course.
  • Medical terminology knowledge, required
  • Minimum of 1 years of healthcare or physician's office related experience in obtaining and handling pre-authorizations
  • Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
  • Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
  • Experience in oncology is a strong preference.
  • Proficiency with MS Office. Must have basic Excel skillset
  • Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred
  • Must be amenable to work during US hours
  • Must be amenable to work onsite

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