Qualifications:

High school diploma or equivalent
Minimum of 1 year of experience in medical prior authorization in a US Healthcare account, insurance verification, or a related healthcare field.
Familiarity with EHR/EMR systems, payer portals, and HIPAA regulations.
Strong attention to detail, organizational, and communication skills.
Ability to manage time efficiently and handle multiple requests in a fast-paced environment.
Customer service orientation with professionalism in interactions with providers and insurance representatives

Key Responsibilities:

Review and verify patient insurance coverage, medical necessity, and provider documentation to determine if prior authorization is required.
Submit prior authorization requests to insurance companies via online portals, fax, or phone.
Follow up on submitted requests to ensure timely approval or to obtain additional information as needed.
Communicate authorization status, denials, or additional requirements to providers, patients, and internal stakeholders.
Document all prior authorization activities accurately and in compliance with HIPAA and internal standards.
Collaborate with clinical teams to ensure all required medical documentation supports the request.
Appeal denied authorization requests, when applicable, by submitting appropriate medical justification and supporting documents.
Stay updated on payer-specific requirements, authorization processes, and policy changes.
Meet productivity and quality metrics as defined by the company and client.

Job Types: Full-time, Permanent

Pay: Php30,000.00 - Php33,000.00 per month

Benefits:

Schedule:

Supplemental Pay:

Experience:

Language:

Location:

Willingness to travel:

Work Location: In person

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