Authorization Representative

Med-Metrix; Pasig; On-site; PHP 334,800 - 446,400; Full time

Benefits offered by this job

8-Hour Shifts, Fixed Weekends Off

Day 1 HMO with 2 dependents covered for FREE

Group Life Insurance

Medical Cash Allowance

Paid Time Off

Job summary

A healthcare services provider located in Metro Manila is seeking an Authorization Representative. This entry-level position requires knowledge of medical terminology and experience in healthcare environments. Duties include obtaining pre-certifications and working with insurance companies. The role is full-time and onsite, aligned with US business hours. Compensation includes comprehensive benefits such as health insurance and allowances.

Qualifications

• Must have completed at least 1 year in college under a medical-allied course.
• Minimum of 1 year of healthcare-related experience in obtaining pre-authorizations.
• Knowledge of medical terminology and associated codes is required.

Responsibilities

• Works with insurance companies for pre-certification/authorization.
• Maintains files and security of confidential information.
• Accurately enters and updates patient data.

Skills

Medical terminology knowledge

Knowledge of CPT Codes

Proficiency with MS Office

Extensive knowledge of payor websites

Experience in healthcare

Education

At least 1 year in college under a medical-allied course

Tools

GE Centricity

EPIC PB

Allscripts

Cerner

Job description

Location: Med‑Metrix Pasig, National Capital Region, Philippines

Position

Authorization Representative

Benefits

• 8‑Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 dependents covered for FREE
• Group Life Insurance
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Holiday Gift
• Bereavement Assistance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

Duties and Responsibilities

• Works effectively with insurance companies to obtain pre‑certification/authorization for services
• Places calls to various health plans to obtain appropriate pre‑certification prior to the patient’s appointment
• Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
• Faxes pre‑certification request form to insurance company
• Maintains files and security of confidential information utilizing host system to scan and input data as per established procedures
• Verifies medical insurance information and documents in scheduling/registration modules
• Reviews claim denials and rejections
• Accurately enters and updates patient data, and other general data, into the computer system
• Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics
• Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
• Demonstrates knowledge of varied managed care insurance and regulatory guidelines
• Meets and maintains daily productivity/quality standards established in departmental policies
• Uses the MPower workflow system, client host system and other tools available to them to collect payments and resolve accounts
• Adheres to the policies and procedures established for the client/team
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with HIPAA standards
• Communicate effectively with physician offices and patients
• Place outbound call to patients with pre‑certification notification
• Work independently from assigned work queues
• Maintain confidentiality at all times
• Maintain a professional attitude
• Other duties as assigned by the management team

Qualifications

• Must have completed at least 1 year in college under a medical‑allied course
• Medical terminology knowledge, required
• Minimum of 1 year of healthcare or physician’s office related experience in obtaining and handling pre‑authorizations
• Extensive knowledge of individual payor websites, including eviCore, Navinet and Novitasphere
• Knowledge of Medical Terminology, CPT Codes, Modifiers and Diagnosis Codes
• Experience in oncology is a strong preference
• Proficiency with MS Office and basic Excel skillset
• Experience with GE Centricity, EPIC PB, Allscripts, Cerner, preferred
• Must be amenable to work during US hours
• Must be amenable to work onsite

Working Conditions

• Work Set‑Up: Onsite
• Work Schedule: US hours, night shift; must be flexible to accommodate business schools
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress
• Work Environment: The noise level in the work environment is usually minimal

Med‑Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non‑merit based factors, or any other characteristic protected by federal, state or local law.

Seniority level

Entry level

Employment type

Full‑time

Job function

Other

Industries

Hospitals and Health Care

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