Night-Shift PHRN: Coverage & Care Navigator

TASQ Staffing Solutions; Pasig; In loco; Tempo pieno

Vantaggi offerti da questo lavoro

Signing bonus available

Descrizione del lavoro

A staffing solutions provider is seeking a Coverage and Access Specialist (PHRN) to support insurance interactions from their office in Pasig, Philippines. Applicants must possess an active PHRN license, with good English skills and a knowledge of healthcare compliance. The role involves managing calls for benefit verifications and case management during the patient journey. Night shift schedules apply and a signing bonus is offered under certain conditions.

Competenze

• Must have an active PHRN license.
• Open to candidates with or without BPO experience.
• One year of prior authorization experience is a plus.

Mansioni

• Interact with insurance payer representatives for benefit verifications.
• Document payer interactions accurately for cross-functional partners.
• Manage cases throughout the patient journey and escalate as needed.

Conoscenze

Good English communication skills

Knowledge of healthcare regulations and compliance

Formazione

Active PHRN license

Descrizione del lavoro

Healthcare Specialist (PHRN / Registered Nurse)

About the job Healthcare Specialist (PHRN / Registered Nurse)

WITH SIGNING BONUS!*
Setup: On-site in Ortigas, Pasig
Schedule: Shifting schedule (predominantly night shift)

Role Requirements:

• Must have an active PHRN license
• With or without BPO experience
• Also open to PHRNs with atleast 1 year in prior authorization OR eligibility, claims, and benefits (payer)
• Knowledge of healthcare regulations and compliance
• Dec. 15, 2025
• Jan. 12, 2026
• Jan. 19, 2026
• Jan. 29, 2026 (PHRNs w/ 1 yr PA/Eligibility/Claims/Benefits exp.)

* Signing bonus - Terms and conditions apply

Responsibilities:

Coverage and Access Specialist (PHRN)

• Professionally and compliantly interact with insurance payer representatives during outbound phone calls for benefit verifications (New BVs, Annual reverification BVs, and Bridge Eligibility Checks) and coverage exception follow-up calls (Prior Authorization (PAS), Non-Formulary Exceptions (NFEs,) and Appeals)
• Volume and case type to be worked to be determined by Novartis, but in collaboration with the supplier, based on current SLAs within the PSC and expected agent productivity
• Accurately and concisely document payer interactions to inform cross-functional partners on the patients' coverage status

Care Navigator (PHRN)

• Develop and maintain Subject Matter Expert (SME) level knowledge of the relevant brand and customer workstreams for the specific assigned program
• Learn and utilize protocols to respond to customer phone, chat, fax, SMS/text, mail, and e-mail inquiries, as well as other communication channels, in a prompt and courteous manner
• Professionally and compliantly interact with customers, relevant Novartis associates, and other external contacts during inbound and outbound phone calls
• Manage assigned cases throughout the patient journey; perform proper and timely escalation, tracking, triage, and follow-up where required