Healthcare Authorization Specialist

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

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.