Prior Authorization and Eligibility Checker | Work From Home

About this role

Salary: 30,000- 40,000 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

Originally posted on Himalayas