Authorization Specialist - WFH

Focusinc Group Corp.; Davao City; Remote; PHP 223,000 - 391,000; Full time

Job summary

Focusinc Group Corp. in the Philippines is seeking an Authorization Specialist to help patients access essential healthcare services by coordinating authorizations between providers and insurers.

You will review clinical documentation, manage requests, and advocate for timely approvals across care levels, while maintaining meticulous records and collaborating with care teams to uphold medical necessity standards.

Qualifications

• At least 6 months of BPO experience in a healthcare account or medical-related field.
• Preferably with experience in Pre-Authorization, Utilization Review, or Case Management.
• Strong probing, critical-thinking, and problem-solving skills to assess clinical information and address authorization concerns effectively.
• Ability to read, understand, and identify relevant information from medical records and clinical documentation.
• Excellent verbal and written communication skills, with the ability to communicate professionally with healthcare providers, insurance companies, clients, and colleagues.
• Strong attention to detail and accuracy when handling documentation, authorization requests, and account updates.
• Ability to prioritize, organize, and manage multiple tasks while meeting deadlines.
• Proficiency in general computer applications, particularly Microsoft Word, Excel, and PDF tools.
• Ability to quickly learn and navigate new software systems and applications.
• Ability to work independently and collaborate effectively as part of a team.
• Flexibility and adaptability in a fast-paced environment with changing priorities and processes.

Responsibilities

• Manage and process daily authorization requests from healthcare providers and facilities, ensuring timely and accurate completion.
• Initiate authorization requests through various insurance portals and direct communication with insurance companies.
• Follow up on pending authorizations, track their status, and address any delays or concerns.
• Prepare and process appeals for denied authorization requests.
• Advocate for patients and providers by coordinating with insurance companies to secure approvals across different levels of care.
• Collaborate with healthcare providers to obtain necessary documentation and clarify medical necessity requirements.
• Respond to inquiries from insurance companies, document relevant information, and communicate updates to providers.
• Review and interpret medical records to identify relevant clinical information needed for authorization requests.
• Maintain accurate account records and update documentation in accordance with client guidelines and established processes.
• Ensure all required forms, logs, and reports are completed accurately, thoroughly, and on time.

Skills

Healthcare BPO

Pre-Authorization

Utilization Review

Case Management

Critical Thinking

Medical Records

Communication Skills

Attention to Detail

MS Office

Team Collaboration

Tools

Microsoft Word

Excel

PDF Tools

Job description

About FGC+

#SparkSuccess at FGC+!

Since 2011, FGC+ has been committed to transforming US businesses through our all-inclusive outsourcing solutions. Through the years, we've built strong remote teams, developed customized processes, and provided exceptional customer service, helping companies soar to new heights. Our dedicated professionals excel in supporting a diverse range of industries with unmatched dedication.

Driven by our core values of Empathy, Reliability, Possibility, and Growth, we are focused on #IgnitingPossibility and helping each team member unlock their full potential. At FGC+, we offer more than just a job; we provide a nurturing environment where work-life balance, mentorship, employee engagement, and continuous learning are the pillars of your success.

Here, you are more than just an employee— you are part of a team where you can truly thrive and make a difference.

About the Job:

Be part of a team that helps patients access the healthcare services they need! As an Authorization Specialist, you will play a vital role in bridging the gap between patients, healthcare providers, and insurance companies. You will review clinical documentation, coordinate authorizations and referrals, and work directly with insurance providers to secure medical necessity approvals. Through your attention to detail and effective communication, you will help ensure patients receive timely access to appropriate healthcare services while supporting providers in delivering quality care.

What You’ll Do:

• Manage and process daily authorization requests from healthcare providers and facilities, ensuring timely and accurate completion.

• Initiate authorization requests through various insurance portals and direct communication with insurance companies.

• Follow up on pending authorizations, track their status, and address any delays or concerns.

• Prepare and process appeals for denied authorization requests.

• Advocate for patients and providers by coordinating with insurance companies to secure approvals across different levels of care.

• Collaborate with healthcare providers to obtain necessary documentation and clarify medical necessity requirements.

• Respond to inquiries from insurance companies, document relevant information, and communicate updates to providers.

• Review and interpret medical records to identify relevant clinical information needed for authorization requests.

• Maintain accurate account records and update documentation in accordance with client guidelines and established processes.

• Ensure all required forms, logs, and reports are completed accurately, thoroughly, and on time.

What You’ll Bring:

• At least 6 months of BPO experience in a healthcare account or medical-related field.

• Preferably with experience in Pre-Authorization, Utilization Review, or Case Management.

• Strong probing, critical-thinking, and problem-solving skills to assess clinical information and address authorization concerns effectively.

• Ability to read, understand, and identify relevant information from medical records and clinical documentation.

• Excellent verbal and written communication skills, with the ability to communicate professionally with healthcare providers, insurance companies, clients, and colleagues.

• Strong attention to detail and accuracy when handling documentation, authorization requests, and account updates.

• Ability to prioritize, organize, and manage multiple tasks while meeting deadlines.

• Proficiency in general computer applications, particularly Microsoft Word, Excel, and PDF tools.

• Ability to quickly learn and navigate new software systems and applications.

• Ability to work independently and collaborate effectively as part of a team.

• Flexibility and adaptability in a fast-paced environment with changing priorities and processes.