PHRN Hiring | Oncology Data Specialist (ODS)/NCRA Certification Required

Omega Healthcare Management Services Inc.; Metro Manila; On-site; PHP 279,000 - 446,000; Full time

Job summary

Omega Healthcare Management Services Inc. in Ortigas is seeking a Precertification Coordinator to obtain prior authorizations and referrals for Cardiac Cath, Cardiac EP, and related procedures. You will review clinical documentation and liaise with payers to secure approvals.

The role requires a valid PHRN license, 1–2 years in BPO, and onsite work. You will handle payer interactions, follow SOPs, and maintain accurate records while delivering quality service.

Qualifications

• Must hold a valid PHRN license.
• Willing to work onsite in Ortigas.
• 1–2 years of experience in business process outsourcing.
• PHRN with prior authorization experience.

Responsibilities

• Prioritize authorization and referral requests by urgency.
• Review patient documentation related to the service.
• Obtain/follow up authorizations from payers via calls, portals, or faxes.
• Respond to payer questions to proceed with requests.
• Follow payer peer-to-peer requirements and relay to providers.
• Handle inbound payer calls and voicemail reviews.

Skills

Anatomy & physiology

Medical terminology

Payer authorizations

Cardiac coding

Computer proficiency

Customer service

Communication skills

Teamwork

Attention to detail

Education

PHRN license

Tools

Microsoft Word

Outlook

PDF

Internet

Job description

About Omega Healthcare Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) is an AI-driven healthcare solutions company that partnersacross the healthcare ecosystem to deliver breakthrough resultsby reimagining and elevating revenue operations.Powered by the Omega Digital Platform®, our agentic AI engineleverages adaptive intelligence to drive automation, complemented by deep human expertise to help optimize performance and deliver sustained financial and clinical outcomes—while enhancing patient satisfaction. Omega Healthcare empowers organizations across provider, payer, and life sciences sectorsto navigate today’s healthcare challenges while building the agility to adapt as healthcare and technology continue to evolve rapidly.Recognized by industry analysts, Omega Healthcare has consistently been ranked a leader in driving operational performance excellence.

Job Purpose

A Precertification Coordinator is responsible for obtaining prior authorizations and referrals on behalf of the provider’s office for Cardiac Cath, Cardiac EP,for Outpatient and Inpatient procedures,

Job Duties and Responsibilities

• Prioritize incoming authorization and referral requests according to queue urgency
• Review patient’s clinical and chart documentation related to the service submitted by the provider’s office
• Obtain and/or follow up on authorization and referral requests from the patient’s payer/s through any of the following methods—depending on the payer’s policy:
  • Perform outbound calls to payer’s authorization department
  • Access payer’s authorization online portal
  • Submit faxes to payer’s authorization department
• Respond to payer’s clinical questions to be able to proceed with the authorization and referral requests
• Obtain and/or follow up payer’s peer-to-peer review requirements and send them back to provider’s office for the actual initiation
• Cater inbound calls from payers and perform necessary actions required for the task
• Listen and review voicemail messages from payers then perform necessary actions required for the task

Required Skills

• Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
• Comprehensive understanding of Medical Terminology
• Prior experience in processing multispecialty authorizations including contact with payers
• Experience in medical coding specially for Cardiac procedures
• Experience with general computer software (Internet, Word, Outlook, PDF required)
• Proficiency to learn new software programs quicklyExcellent customer service skills: communicates clearly and effectively
• Excellent verbal and written communication skills
• Professional and effective interaction skills with co-workers, clients, providers, and vendors
• Proven ability to work well individually and as a team member
• Strong attention to detail
• Ability to follow company and account-specific standard operating procedures and policies
• Ability to adapt to constantly changing environment
• Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand
• Ability to remain organized with multiple interruptions
• Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies
• Ability to comfortably receive constructive feedback

Qualifications:

1.Must hold a valid PHRN license

2.Willing to work onsite in Ortigas

3. At least 1 year of experience in any of the following:

• 1–2 years of experience in business process outsourcing

• PHRN with prior authorization experience