Deskripsi Pekerjaan
We are looking for a detailâoriented Prior Authorization Specialist to join our growing healthcare team in Quezon City, Metro Manila. In this role, you will be responsible for processing prior authorization requests, coordinating with insurance providers, and working closely with clinical teams to secure timely approvals for patient treatments.
You will serve as the key liaison between physicians, patients, and insurers, ensuring that all required documentation is accurate and submitted within the designated timeframes. Your expertise will help minimize treatment delays, improve patient satisfaction, and support the overall efficiency of our healthcare services.
The ideal candidate thrives in a fastâpaced environment, possesses strong communication skills, and has a solid understanding of medical billing and healthcare regulations. If you are passionate about patient care and enjoy navigating the intricacies of insurance authorization, we would love to hear from you.
Tanggung Jawab
- Review and process prior authorization requests for medical procedures, medications, and diagnostic tests.
- Collaborate with physicians, nurses, and other clinical staff to gather necessary clinical information and documentation.
- Liaise with insurance companies and thirdâparty payers to verify coverage, resolve issues, and follow up on pending authorizations.
- Maintain accurate records of all authorization activities in the electronic health record (EHR) system.
- Ensure compliance with healthcare regulations, payer policies, and facility standards.
- Educate patients and families on authorization procedures, coverage details, and potential outâofâpocket costs.
- Identify process improvements and recommend solutions to reduce turnaround times and denials.
Kualifikasi
- Minimum of 2 years of experience in medical billing, coding, or prior authorization within a healthcare setting.
- Strong knowledge of insurance plan requirements, CPT/ICDâ10 codes, and authorization guidelines.
- Excellent written and verbal communication skills for effective interaction with clinicians, payers, and patients.
- Proficiency in EHR systems and Microsoft Office applications.
- Ability to work under pressure, manage multiple tasks, and meet tight deadlines.
- Attention to detail and strong analytical problemâsolving abilities.
- High school diploma or equivalent required; associate or bachelorâs degree in health administration or related field preferred.
- Certification in medical billing or prior authorization (e.g., CPC, CPB) is a plus.