Onsite Insurance Verification & Authorization Specialist

John Clements Consultants, Inc.; Pasig; On-site; PHP 360,000 - 480,000; Full time

Benefits offered by this job

On-site work

Bridgetowne, Pasig City location

Job summary

John Clements Consultants, Inc. seeks a healthcare verification professional to verify insurance coverage, obtain benefit information, and document patient accounts.

The role involves collaborating with patients, providers, and internal teams to ensure accurate registrations and timely processing. The ideal candidate will have a minimum of 2 years in prior authorization, pre-certification, or insurance verification, with orthopedic experience preferred and strong knowledge of payer requirements.

Qualifications

• Bachelor degree graduates.
• Minimum 2 years in prior authorization, pre-certification, or insurance verification.
• Orthopedic experience preferred.
• Strong knowledge of insurance authorization processes and payer requirements.
• Familiarity with CPT, ICD-10, and medical terminology.

Responsibilities

• Utilize real-time eligibility (RTE) tools to verify health plan coverage, accurate insurance package registration, and obtain benefit information.
• Communicate effectively with patients, providers, or internal teams to obtain missing information and ensure continuity of care and service.
• Ensure all insurance coverage and relevant benefits are accurately documented in the patient account.
• Maintain team work queues to ensure timely review and processing of all incoming insurance verification requests.
• Provide accurate TOS estimates based on verified benefits to communicate patient financial responsibility electronically, including copays, coinsurance, deductibles, and out-of-pocket costs.
• Proactively identify patients requiring referrals via worklists. Obtain required referrals and/or authorizations in accordance with payer requirements; follow up with patients, providers, and payer sources as needed.
• Collaborate with front office, clinical teams, and other partnering departments to verify correct package registration, confirm network status, and resolve coverage discrepancies ensuring timely resolutions for any account requested.
• Answer transferred patient phone calls through assigned ring group(s) in accordance with established participation standards to address insurance benefit inquiries.
• Utilize centralized communication platform for position resources, announcements, PTO planning, etc.
• Support the Contact Center during peak volume periods.

Skills

Communication skills

Organizational skills

Time management

Customer service

Multitasking

Written communication

Education

Bachelor degree graduates

Tools

EHR systems

Pre-certification platforms

Payer portals

Job description

John Clements Consultants, Inc. seeks a healthcare verification professional to verify insurance coverage, obtain benefit information, and document patient accounts.

The role involves collaborating with patients, providers, and internal teams to ensure accurate registrations and timely processing. The ideal candidate will have a minimum of 2 years in prior authorization, pre-certification, or insurance verification, with orthopedic experience preferred and strong knowledge of payer requirements.