Pre Authorization Nurse

2 weeks ago

Manila, National Capital Region, Philippines CASM Limitlessli LLC Full time ₱600,000 - ₱800,000 per year

At Limitlessli we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering tailored services to meet our clients' unique business needs.

The Opportunity:

The Pre-Authorization Nurse is responsible for reviewing, researching, and resolving prior authorization inquiries to support timely and accurate care delivery. This role manages incoming requests from various interdepartmental and intradepartmental channels, ensuring efficient communication and rapid issue resolution. The nurse will monitor designated chat channels, prioritize urgent authorization needs, and utilize strong clinical judgment and documentation expertise to support the authorization process.

This position is remote and offers you the flexibility of working from home.

Key Responsibilities

  • Prior Authorization & Clinical Review

  • Review and process prior authorization requests in a timely and accurate manner.

  • Apply AMS and chart review expertise to validate clinical information and ensure authorization requirements are met.
  • Research and resolve incoming inquiries related to authorization, billing, and care coordination.

  • Communication & Issue Resolution

  • Serve as a primary responder for the Client Axxess/QA Chat Channel and Outstanding Billing Check-In Chat Channel.

  • Monitor specified chat channels continuously to ensure fast and effective handling of requests.
  • Collaborate with internal teams (billing, QA, clinical, scheduling) to obtain required information and resolve outstanding issues.

  • Coordination & Documentation

  • Ensure all actions and decisions are appropriately documented within the EMR and internal systems.

  • Communicate authorization outcomes clearly to relevant departments.
  • Escalate complex issues to leadership when appropriate.

  • Quality & Compliance

  • Adhere to organizational policies, payer guidelines, state regulations, and documentation standards.

  • Support compliance initiatives and contribute to process improvements in the prior authorization workflow.
Qualifications

Required

  • Prior experience in utilization management, prior authorization, case management, or clinical documentation.
  • Strong understanding of clinical guidelines and medical necessity criteria.
  • Ability to prioritize high-volume, time-sensitive tasks.
  • Excellent communication and critical-thinking skills.
  • Proficiency with EMR systems (Axxess preferred) and digital communication channels.

Preferred

  • Experience in home health, hospice, or managed care environments.
  • Familiarity with payer requirements and pre-auth workflows for Medicare, Medicaid, and commercial plans.
  • Knowledge of QA processes and billing workflows.
Service Fee:

Industry standards applicable to the state depending on work experience and level of expertise.

Hours:

US Eastern Standard Time (EST) - 9am to 6pm

Why Limitlessli?

We embrace the flexibility and convenience of a remote working environment, and you will collaborate with an international team while contributing to our growing business, all from the comfort of your home.

Essential requirements:

You will need to have some essential tools – a reliable computer and noise-cancelling headset, a second monitor for enhanced productivity, and a stable internet connection. You'll also be required to have a backup internet connection, ensuring that you're well-equipped to complete your work seamlessly.

Don't miss out on this opportunity – apply now and become a valuable member of the Limitlessli team If you're interested in what you have read, then we invite you to take the next step and submit your application.

APPLY NOW

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