Prior Authorization and Eligibility Checker

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Receive requests for prior authorizations through the Scheduling Module of the Electronic Health Record (EHR) and/or via phone or fax, ensuring they are meticulously monitored.

• Process referrals and submit medical records to insurance carriers to facilitate prior authorization procedures.

• Evaluate the patient's medical history and insurance coverage to secure approval.

• Manage correspondence with insurance companies, physicians, specialists, and patients as required, including appropriate documentation in the EHR.

• Assist in the preparation of necessary documentation to speed up approvals and ensure proper follow-up.

• Assess the accuracy and completeness of requested information, ensuring all supporting documents are included.

• Adhere to team and/or client's established procedures, policies, and methodologies as directed.

• Carry out other related tasks as needed or assigned.

• Verify insurance eligibility for both new and established patients by reaching out to insurance companies and utilizing online verification systems.

• Examine insurance plans to confirm adequate coverage for Senior/Elder Care, including wellness visits, screenings, and vaccinations.

• Validate patient benefits, co-pays, deductibles, and specific requirements or limitations related to Senior Care.

• Provide patients with comprehensive information about coverage, including potential out-of-pocket expenses.

⛳️ Requirements

• Bachelor’s Degree holder (preferably in a Medical-related field, although not mandatory).

• Minimum of 6 months consultancy contract on a consultancy basis (renewal subject to agreement).

• At least 1 year of experience with Prior Authorization in a BPO healthcare setting is advantageous.

• Exceptional English communication skills, both verbal and written.

• Capability to prioritize and organize multiple tasks effectively.

• Strong communication abilities and a customer-centric approach.

• Willingness to work in shifting schedules, predominantly night shifts.

• Capability to work from home.

• Must possess a reliable internet connection.

🏝️ Benefits

• Work from home.

• Equipment/company computer provided.