Insurance Verification & Authorization Lead

John Clements Consultants, Inc.; Pasig; On-site; PHP 420,000 - 630,000; Full time

Job summary

John Clements Consultants, Inc. is seeking an Account Specialist Supervisor to lead a team in Pasig, focusing on insurance verification, benefits review, and patient financial workflows.

The role demands strong leadership and expertise in payer requirements and EHR systems. You will monitor queues, coach staff, and collaborate with front office and clinical teams to ensure accurate coverage, timely authorizations, and smooth financial clearance for patients.

Qualifications

• Bachelor's degree in healthcare administration, business, or related field.
• 3–5 years in patient access, insurance verification, benefits, referrals, revenue cycle, physician office, or hospital environment.
• 1+ year in lead, supervisory, training, quality review, or workflow coordination experience.
• Orthopedic experience strongly preferred.
• Strong knowledge of insurance verification, benefit interpretation, prior authorization, referral processes, payer requirements, and patient financial responsibility workflows.
• Familiarity with CPT, ICD-10, medical terminology, clinical documentation, and payer medical necessity guidelines.
• Proficiency with EHR systems, eligibility tools, pre-certification platforms, payer portals, Microsoft Office, and reporting tools.
• Leadership and team development skills with ability to coach team members, resolve escalations, monitor performance, and support process improvement.
• Excellent communication, organization, analytical, problem-solving, and time-management skills.

Responsibilities

• Supervise day-to-day operations of the Account Specialist team, including insurance verification, benefits review, package registration, referral requirements, authorization support, and patient financial responsibility workflows.
• Monitor work queues, productivity, quality, turnaround times, and service levels to ensure timely completion of insurance verification and account review activities.
• Serve as a subject matter expert for complex payer requirements, real-time eligibility tools, payer portals, referrals, benefit interpretation, network status, provider participation, and documentation standards.
• Review and validate team documentation to ensure insurance coverage, detailed benefits, referrals, authorizations, and patient financial responsibility estimates are accurately recorded in the patient account.
• Provide coaching, feedback, training, and ongoing development to Account Specialists to support accuracy, productivity, customer service, and policy adherence.
• Manage escalated patient, provider, payer, and internal team inquiries related to insurance benefits, referrals, authorizations, package registration, and account discrepancies.
• Partner with front office, clinical teams, Contact Center, Revenue Cycle, and leadership to resolve workflow barriers, reduce registration errors, improve financial clearance, and support continuity of care.
• Prepare, review, and communicate productivity, quality, staffing, and operational performance updates as requested by leadership.
• Support staffing coordination, PTO planning, coverage needs, and workload balancing to maintain consistent team performance and service delivery.
• Identify opportunities for process improvement and assist with developing standard work, resources, and quality assurance practices.

Skills

Leadership

Insurance verification

Payer portals

Coaching

Process improvement

Communication

EHR systems

Problem solving

Education

Bachelor's degree

Tools

EHR systems

Payer portals

MS Office

Reporting tools

Job description

John Clements Consultants, Inc. is seeking an Account Specialist Supervisor to lead a team in Pasig, focusing on insurance verification, benefits review, and patient financial workflows.

The role demands strong leadership and expertise in payer requirements and EHR systems. You will monitor queues, coach staff, and collaborate with front office and clinical teams to ensure accurate coverage, timely authorizations, and smooth financial clearance for patients.