Prior Authorization and Eligibility Checker

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