PHRN Prior Auth | Acute Care Experience Preferred (ER, ICU, Med-Surg, OR)

Omega Healthcare Management Services Inc.; Eastern Manila District; On-site; PHP 223,000 - 312,000; Full time

Job summary

Omega Healthcare Management Services Inc. is seeking a Precertification Coordinator to obtain prior authorizations and referrals for cardiac procedures. You will engage payers, review clinical documentation, and ensure timely processing of authorizations, working closely with provider offices.

The role emphasizes attention to detail, solid medical terminology knowledge, and strong communication skills, with onsite work in Ortigas and ongoing interaction with payer staff.

Qualifications

• PHRN license must be valid and current.
• Onsite work at Ortigas is required.
• Minimum 1 year of experience in BPO or healthcare admin.
• PHRN with prior authorization experience is preferred.
• Strong attention to detail and communication skills.
• Proficiency with MS Word, Outlook and PDF workflows.

Responsibilities

• Prioritize incoming authorization and referral requests by queue urgency.
• Review patient charts and clinical information related to the service.
• Obtain and follow up on authorizations/referrals from payers via calls, portals or faxes.
• Respond to payer clinical questions to proceed with authorization requests.
• Coordinate payer peer-to-peer review requirements and relay results to providers.
• Cater inbound payer calls and review voicemail messages as needed.

Skills

Anatomy & physiology

Medical terminology

Multispecialty authorizations

Medical coding

Customer service

Verbal and written communication

Attention to detail

Adaptability

Team collaboration

Education

PHRN license

Tools

Microsoft Word

Outlook

PDF workflows

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:

o Perform outbound calls to payer’s authorization department

o Access payer’s authorization online portal

o 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 quickly

· Excellent 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