22 Prior Authorization Specialist jobs in the Philippines

Urgent hiring for Medical Claims Analyst-Back Office (Local HMO Company)

Company Name: Outsource Network (ONET)
Cebu office: 8F APPLEONE EQUICOM TOWER CEBU BUSINESS PARK, CEBU CITY
- NO LICENSE OR EXPERIENCE REQUIRED!
- FRESH GRADUATES ARE ENCOURAGED TO APPLY! Nurse, Pharmacy, MedTech, Radtech, BS Biology, Nutrition Dietician or any equivalent course
- FIXED SHIFT SCHEDULE
- CAN START ASAP
- HMO UPON REGULARIZATION
- 5 WORKING DAYS
- NON-VOICE
- FRIENDLY ENVIRONMENT
- PERFORMANCE APPRAISAL
- WILLING TO WORK IN CEBU CITY

BASIC FUNCTIONS:

- Manages and processes insurance claims.
- Review and assesses the claims, remitting payment to the doctor if a claim is covered by the patient’s insurance policy.
- Adjudicate payment to the doctor and hospitals.
- Must meet daily quota
- Responsible for reading diagnosis
- Evaluating laboratories

Please text us at with your details and our recruiters will call you ASAP.
Full name:
Course/Educational Attainment:
Mobile #:
Position Applied:
**Job Types**: Full-time, Fresh graduate, Permanent

**Salary**: Php10,000.00 - Php12,000.00 per month

**Benefits**:

- Health insurance
- Paid training

Schedule:

- 8 hour shift
- Day shift
- Fixed shift

Supplemental Pay:

- 13th month salary
- Performance bonus

Application Question(s):

- If undergraduate, what year level?
- Expected salary?

**Education**:

- Elementary/ Primary school (preferred)

**_What Customer Service Operations contributes to Cardinal Health_**
Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution.
Customer Service Operations is responsible for providing outsourced services to customers relating to medical billing, medical reimbursement, and/or other services by acting as a liaison in problem-solving, research and problem/dispute resolution.
**_Job Summary_**
The Insurance Verification Supervisor assists the Insurance Verification Manager in overseeing the insurance verification process, ensuring efficient and accurate verification of patient insurance coverage and authorizations. They provide direct supervision to a team of insurance verification specialists, supporting their development and ensuring adherence to established procedures and standards.
**_Responsibilities_**
+ Supervises and support a team of insurance verification specialists.
+ Provides training, coaching, and mentorship to team members to enhance their skills and performance.
+ Fosters a collaborative and positive work environment conducive to achieving team goals.
+ Assists in the development and implementation of standardized procedures for insurance verification.
+ Oversees and participates in the verification of patient insurance coverage, ensuring accuracy and timeliness.
+ Supports team members in resolving insurance-related inquiries and discrepancies.
+ Assists in coordinating the authorization process for medical procedures and services requiring pre-authorization.
+ Communicates with insurance companies to obtain authorizations and resolve authorization-related issues.
+ Monitors authorization status and escalate issues as necessary to ensure timely approvals.
+ Collaborates with billing and coding teams to address insurance-related claim rejections and denials.
+ Assists in investigating and resolving discrepancies in insurance coverage and billing information.
+ Provides guidance to team members on optimizing claim submission and reimbursement processes.
+ Conducts regular training sessions and provide ongoing support to ensure team members are proficient in insurance verification procedures and software.
+ Identifies training needs and opportunities for professional development among team members.
+ Encourages continuous learning and skill enhancement within the team.
+ Assists in ensuring compliance with HIPAA regulations and other relevant healthcare laws and regulations
+ Conducts periodic audits of insurance verification processes to ensure accuracy and compliance.
+ Collaborates with the Insurance Verification Manager to implement improvements and address areas for enhancement
+ Embraces and exemplifies the Cardinal Health values: _Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others_
**_Other Responsibilities_**
- May perform any additional responsibilities or special projects as required.
- May provide cross-functional support as business needs demand.
- Duties and responsibilities may be subject to change based upon the needs of the department.
**_Qualifications_**
**Internal**
(1) No Disciplinary actions for the past 12 months
(2) At least 1 year of tenure in current role
(3) Knowledge in Healthcare Operations specifically Insurance Verification is required
**External**
(1) At least 2 years of college coursework or experience
(2) 2 years of Leadership experience
(3) Knowledge in Healthcare Operations specifically Insurance Verification is required
(4) Experience in using Contact Center phone system such as NICE and/or Genesys is an advantage
**_Expected Competencies_**
- Professional, and effective communications skills; able to calmly present solutions in challenging situations.
· Proactive identification of challenges, and solution-oriented approach to problem solving.
· Service-orientation and aptitude to utilize proper listening skills.
· Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.
· Self-directed accountability and reliability
· Effective leadership, communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.
· Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.
· Able to work well in a team environment that promotes inclusiveness and communication among team members.
· Communication using both verbal and written English proficiency.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (

Quality Auditor hiring Clinical Authorization Process.

Onsite, Night Shift, Mon-Friday

Qualifications

• Must hold an active PHRN license (not a USRN license holder)
• Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review is preferred
• Strong familiarity with EPIC , MCG , or InterQual guidelines required
• Demonstrated job stability , with a consistent employment history and minimal transitions

Job Description

I. Audit

• Completing QA audits for their processes by following the QIP
• Providing feedback to team members on all errors
• Escalating any anomalies / trends / Compliance issues
• Performing the actual production work to keep abreast of the latest updates and practical scenarios
• Participating in client calls to capture process updates and monitoring compliance to the updates

II. Process

• Contact insurance carriers to verify patients 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

**_What Customer Service Operations contributes to Cardinal Health_**
Customer Service is responsible for establishing, maintaining and enhancing customer business through contract administration, customer orders, and problem resolution.
Customer Service Operations is responsible for providing outsourced services to customers relating to medical billing, medical reimbursement, and/or other services by acting as a liaison in problem-solving, research and problem/dispute resolution.
**_Job Summary_**
The Insurance Verification Supervisor assists the Insurance Verification Manager in overseeing the insurance verification process, ensuring efficient and accurate verification of patient insurance coverage and authorizations. They provide direct supervision to a team of insurance verification specialists, supporting their development and ensuring adherence to established procedures and standards.
**_Responsibilities_**
+ Supervises and support a team of insurance verification specialists.
+ Provides training, coaching, and mentorship to team members to enhance their skills and performance.
+ Fosters a collaborative and positive work environment conducive to achieving team goals.
+ Assists in the development and implementation of standardized procedures for insurance verification.
+ Oversees and participates in the verification of patient insurance coverage, ensuring accuracy and timeliness.
+ Supports team members in resolving insurance-related inquiries and discrepancies.
+ Assists in coordinating the authorization process for medical procedures and services requiring pre-authorization.
+ Communicates with insurance companies to obtain authorizations and resolve authorization-related issues.
+ Monitors authorization status and escalate issues as necessary to ensure timely approvals.
+ Collaborates with billing and coding teams to address insurance-related claim rejections and denials.
+ Assists in investigating and resolving discrepancies in insurance coverage and billing information.
+ Provides guidance to team members on optimizing claim submission and reimbursement processes.
+ Conducts regular training sessions and provide ongoing support to ensure team members are proficient in insurance verification procedures and software.
+ Identifies training needs and opportunities for professional development among team members.
+ Encourages continuous learning and skill enhancement within the team.
+ Assists in ensuring compliance with HIPAA regulations and other relevant healthcare laws and regulations
+ Conducts periodic audits of insurance verification processes to ensure accuracy and compliance.
+ Collaborates with the Insurance Verification Manager to implement improvements and address areas for enhancement
+ Embraces and exemplifies the Cardinal Health values: _Invites Curiosity, Builds Partnerships, Inspires Commitment, Develops Self and Others_
**_Other Responsibilities_**
- May perform any additional responsibilities or special projects as required.
- May provide cross-functional support as business needs demand.
- Duties and responsibilities may be subject to change based upon the needs of the department.
**_Qualifications_**
**Internal**
(1) No Disciplinary actions for the past 12 months
(2) At least 1 year of tenure in current role
(3) Knowledge in Healthcare Operations specifically Prior Authorization
**External**
(1) At least 2 years of college coursework or experience
(2) 2 years of Leadership experience
(3) Knowledge in Healthcare Operations specifically Prior Authorization is required
(4) Experience in using Contact Center phone system such as NICE and/or Genesys is an advantage
**_Expected Competencies_**
- Professional, and effective communications skills; able to calmly present solutions in challenging situations.
· Proactive identification of challenges, and solution-oriented approach to problem solving.
· Service-orientation and aptitude to utilize proper listening skills.
· Effective analytical skills: able to use inductive and deductive reasoning to anticipate outcomes.
· Self-directed accountability and reliability
· Effective leadership, communication, and interpersonal skills, with the ability to influence and collaborate effectively with cross-functional teams.
· Able to manage and prioritize multiple tasks/projects, work autonomously, and meet deadlines.
· Able to work well in a team environment that promotes inclusiveness and communication among team members.
· Communication using both verbal and written English proficiency.
_Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply._
_Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal_ _Opportunity/Affirmative_ _Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law._
_To read and review this privacy notice click_ here (