Pre-Certification Specialist

3 days ago

Cebu City, Central Visayas, Philippines Tahche Outsourcing Services Inc. Full time ₱200,000 - ₱400,000 per year

Our US partner is one of the leading Medical Digital Imaging Service Providers in New Jersey. They offer a full spectrum of diagnostic imaging services in comfortable, convenient, and friendly outpatient imaging centers.

As a Pre-Certification Specialist, you are responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribing and triaging patient calls to physicians, and coordinating patient appointments/orders.

This is a full-time role, on a US shift and on a Work in the office set-up.

If you have the right skill set, this may be your opportunity to enter this fast-growing organization.

DUTIES AND RESPONSIBILITIES:

● Responsible for day-to-day monitoring of the Radiology Worklist.

● Sorting of cases based on priority.

● Calling out to Insurance Companies for insurance verification, referrals and auth process.

● Case creation in eviCore or another Insurance Portal as required.

● Request additional clinicals as needed.

● Review clinicals received and ensure it meets insurance clinical guidelines for authorization.

● Monitoring of pending cases for approval or denials

● Make necessary follow-ups on insurance, clinics on pending/denied cases.

● Take action on pending cases if it requires additional clinicals, CPT recommendations, and

among others.

● Notification to the provider or medical assistant for pending or denied cases.

● Other tasks as given by an immediate superior.

QUALIFICATIONS:

● At least 2nd-year level/Graduate/Postgraduate/ Doctorate degree in Life Sciences

● With at least 1 year and above experience in obtaining Pre-Authorization in a healthcare

environment.

● Knowledgeable in CPT codes and DX codes

● Familiar with different insurance portals and websites

ESSENTIAL SKILLS:

● Good verbal and written communication

● Detail Oriented

● Good understanding of the Pre-Certification Process

WHAT'S IN IT FOR YOU? (Be part of a Dynamic US Team)

● Experience work-life balance while working the night shift with weekends off rest days

● Full-time permanent position

● Competitive base salary with allowance

● 13th-month pay

● Paid Leaves and Service Incentive Leaves

● Health insurance with dental coverage upon regularization with the opportunity for an

additional 2 dependents

● We cover Government-mandated benefits (SSS, Phil health, Pag Ibig, Maternity or Paternity

leave benefit, Solo Parent Leave, etc.)

● Participate in a variety of activities, including team outings, sports events, and other fun

events to foster camaraderie.

Job Types: Full-time, Permanent

Pay: Php25, Php30,000.00 per month

Benefits:

  • Health insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise

Work Location: In person

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