Lead Prior Authorization & Eligibility Specialist

PM Consulting; Philippines; On-site; PHP 391,000 - 614,000; Full time

Job summary

PM Consulting in the Philippines is seeking an experienced Account Specialist in Patient Access to lead insurance verification, benefits interpretation, referrals, and authorization support onsite in Bridgetowne, Quezon City during night shift.

You will monitor productivity, coach staff, ensure compliance with payer requirements and privacy rules, and collaborate with Front Office, Clinical, and Revenue Cycle teams to improve workflows.

Qualifications

• Experience in Patient Access, Insurance Verification, and authorizations preferred.
• Knowledge of CPT/ICD-10 and payer medical necessity guidelines.
• Strong leadership and communication skills; able to coach and resolve conflicts.
• Orthopedic experience is strongly preferred.

Responsibilities

• Oversee daily insurance verification, benefits review, referrals, and authorization support.
• Monitor productivity, quality, turnaround times, and service levels.
• Serve as SME on payer requirements, eligibility, and provider participation.
• Ensure accuracy and compliance of team documentation.
• Provide coaching, feedback, and performance development.

Skills

Insurance verification

Benefits review

Authorization support

Team leadership

Coaching

Performance management

Workflow improvement

Payer requirements

Communication

Problem solving

Education

High school diploma or equivalent

Associate's or Bachelor's in Healthcare Administration or related field preferred

Tools

EHR systems

Eligibility tools

Pre-certification platforms

Payer portals

Microsoft Office

Reporting tools

Job description

PM Consulting in the Philippines is seeking an experienced Account Specialist in Patient Access to lead insurance verification, benefits interpretation, referrals, and authorization support onsite in Bridgetowne, Quezon City during night shift.

You will monitor productivity, coach staff, ensure compliance with payer requirements and privacy rules, and collaborate with Front Office, Clinical, and Revenue Cycle teams to improve workflows.