Prior Authorization Specialist

Join us as a Prior Authorization Specialist, overseeing patients’ HMO insurance participation. Work with insurance case managers, billing staff, and skilled nursing facilities to ensure current authorizations and timely documentation.

Job Description

A Prior Authorization Specialist monitors and manages patients’ overall HMO insurance involvement. They coordinate with insurance case managers, billing staff, and skilled nursing facilities to ensure that authorizations are up to date and necessary documents are prompt.

Responsibilities

Ensure every HMO insurance-managed patient in this category is admitted with the proper authorization and benefits for short-term rehabilitation.
Real-time tracking of relevant authorizations.
Ongoing communication with the insurance case manager for continued authorizations and matched with each patient’s level of care. This includes the submission of comprehensive—clinical updates to the insurance provider.
HMO Notice of Non-Coverage and other HMO denial coordination.
Communication with the billing departments to facilitate claim submission and monthly pre-billing triple checks for all authorized days.
Denial management — including tracking, response, and appeal.
Participation in the SNF’s utilization review meetings.
Real-time communication with the SNF’s interdisciplinary team.

Minimum Qualifications

With experience in insurance verification and authorization.
Familiar with medical terminology.
Strong communication skills.

Date Posted:

7 hours ago

Location:

SJDM, Bulacan

Title:

Prior Authorization Specialist

Job Type:

Full-time

Category:

Non-Clinical

Account:

Voice and non-voice accounts

Shift:

Night Shift

Experience Level:

Professionals with healthcare BPO experience of at least 1-2 years or a degree holder of any medical related field.