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Prior Authorization and Eligibility Checker Specialist | Work From Home

Key Facts

Remote From: 
Full time
English

Other Skills

  • •
    Communication
  • •
    Multitasking
  • •
    Detail Oriented
  • •
    Prioritization

Roles & Responsibilities

  • Bachelor's degree (preferably in Medical, but not required).
  • Consultancy basis minimum of 6 months consultancy contract (subject for renewal).
  • At least 1 year of prior authorization experience under a BPO healthcare account (advantage).
  • Excellent English communication skills (written and oral); ability to prioritize and organize multiple tasks; strong customer-centric approach; willing to work in shifting/night shifts; able to work from home with reliable internet.

Requirements:

  • Receive and monitor requests for prior authorizations via the EHR Scheduling Module, phone, or fax.
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
  • Review patient medical history and insurance coverage for approval; manage correspondence with insurance companies, physicians, specialists, and patients, including EHR documentation.
  • Verify information accuracy and completeness; ensure all supporting documents are present; assist with documentation to expedite approvals and follow-up.

Job description

Salary: 30,000- 50,000 PHP/ month

Job Description:

  • Receive requests for prior authorizations using the Scheduling Module of the Electronic Health Record (EHR) and/or via phone or fax and ensure that they are closely monitored.
  • Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
  • Review the patient's medical history and insurance coverage for approval.
  • Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
  • Assist with the necessary documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
  • Follow team and/or client's proper procedures, policies, and methodologies as instructed.
  • Performs other related duties as necessary or assigned

Eligibility and Benefits Verification:

  • Verify insurance eligibility for new and established patients by contacting insurance companies and using online verification systems.
  • Review insurance plans to ensure proper coverage for Senior/Elder Care (e.g., wellness visits, screenings, and vaccinations).
  • Confirm patient benefits, co-pays, deductibles, and any specific requirements or limitations for Senior Care.
  • Provide patients with detailed information regarding their coverage, including potential out-of-pocket costs.

Minimum Qualifications:

  • Graduate of Bachelor's Degree (preferably in Medical, but not required)
  • Consultancy basis minimum of 6 months consultancy contract (subject for renewal)
    • At least 1 year of background with Prior Authorization under a BPO healthcare account is an advantage
    • Must have excellent English communication skills, both written and oral
    • Ability to prioritize and organize multiple tasks
    • Strong communication skills and customer centric
    • Willing to work in shifting schedules, mostly night shift
    • Able to work from home, must have a reliable internet connection

    Others:

    • Equipment/ company computer is provided
    • Work from Home

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