Clinical Data Abstractor

Omega Healthcare Management Services; Pasig; On-site; PHP 250,000 - 350,000; Full time

Job summary

Omega Healthcare Management Services is seeking a Precertification Coordinator to obtain prior authorizations and referrals for Cardiac Cath and Cardiac EP procedures, both outpatient and inpatient, on behalf of the provider’s office.

You will prioritize requests, review clinical documentation, contact payers, and manage portal submissions, faxes, and follow-ups, while ensuring payer questions are answered.

Qualifications

• Must hold a valid PHRN license.
• Willing to work onsite in Ortigas.
• 1–2 years of experience in BPO, with prior authorization experience.

Responsibilities

• Prioritize incoming authorization and referral requests according to queue urgency.
• Review patient’s clinical and chart documentation related to the service submitted by the provider’s office.
• Obtain and/or follow up on authorization and referral requests from the payer via portals, calls or faxes.
• Respond to payer’s clinical questions to proceed with the authorization.
• Follow up payer peer-to-peer review requirements and return them to the provider.
• Cater inbound calls from payers and perform necessary actions.
• Review voicemail messages from payers and take needed actions.

Skills

Anatomy knowledge

Medical terminology

Payer authorizations

Cardiac procedures

Effective communication

Team collaboration

Attention to detail

Independent decision making

Customer service

Education

PHRN license

Tools

Microsoft Word

Outlook

PDF

Internet

Job description

A Precertification Coordinator is responsible for obtaining prior authorizations and referrals on behalf of the provider’s office for Cardiac Cath, Cardiac EP,for Outpatient and Inpatient procedures,

Job Duties and Responsibilities

• Prioritize incoming authorization and referral requests according to queue urgency
• Review patient’s clinical and chart documentation related to the service submitted by the provider’s office
• Obtain and/or follow up on authorization and referral requests from the patient’s payer/s through any of the following methods—depending on the payer’s policy:
  • Perform outbound calls to payer’s authorization department
  • Access payer’s authorization online portal
  • Submit faxes to payer’s authorization department
• Respond to payer’s clinical questions to be able to proceed with the authorization and referral requests
• Obtain and/or follow up payer’s peer-to-peer review requirements and send them back to provider’s office for the actual initiation
• Cater inbound calls from payers and perform necessary actions required for the task
• Listen and review voicemail messages from payers then perform necessary actions required for the task

Required Skills

• Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
• Comprehensive understanding of Medical Terminology
• Prior experience in processing multispecialty authorizations including contact with payers
• Experience in medical coding specially for Cardiac procedures
• Experience with general computer software (Internet, Word, Outlook, PDF required)
• Proficiency to learn new software programs quickly
• Excellent customer service skills: communicates clearly and effectively
• Excellent verbal and written communication skills
• Professional and effective interaction skills with co-workers, clients, providers, and vendors
• Proven ability to work well individually and as a team member
• Strong attention to detail
• Ability to follow company and account-specific standard operating procedures and policies
• Ability to adapt to constantly changing environment
• Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand
• Ability to remain organized with multiple interruptions
• Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies
• Ability to comfortably receive constructive feedback

Qualifications:

• Must hold a valid PHRN license
• Willing to work onsite in Ortigas
• At least 1 year of experience in any of the following:
• 1–2 years of experience in business process outsourcing
• PHRN with prior authorization experience