Pre-Certification Specialist

Tahche Outsourcing Services Inc; Cebu City; On-site; PHP 246,000 - 469,000; Full time

Job summary

Tahche Outsourcing Services Inc. in Cebu City is seeking a detail-oriented Healthcare Authorization Specialist to support radiology case management.

You will monitor the radiology worklist daily, prioritize cases, contact insurance for verification and referrals, and create cases in eviCore or similar portals. The role requires 6 months+ experience in pre-authorization within healthcare, knowledge of CPT and DX codes, and familiarity with insurance portals.

Qualifications

• 2nd-year level or higher in Life Sciences
• At least 6 months of Pre-Authorization experience in healthcare
• Knowledgeable in CPT and DX codes
• Familiar with insurance portals and websites

Responsibilities

• Monitor day-to-day Radiology Worklist.
• Sort cases by priority.
• Call Insurance for verification, referrals and auth process.
• Create cases in eviCore or other insurance portals as required.
• Request additional clinicals as needed.
• Review clinicals for insurance authorization per guidelines.
• Monitor pending cases for approval or denials and follow up.
• Follow up on pending/denied cases and CPT recommendations as needed.
• Notify provider or medical assistant about pending or denied cases.
• Perform other tasks as directed by superior.

Skills

Insurance verification

Pre-Authorization

CPT codes

DX codes

Insurance portals

Education

Life Sciences degree or higher

Tools

eviCore

Job description

Job Description

DUTIES AND RESPONSIBILITIES

• Responsible for day-to-day monitoring of the Radiology Worklist.
• Sorting of cases based on priority.
• Calling out to Insurance Companies for insurance verification, referrals and auth process.
• Case creation in eviCore or another Insurance Portal as required.
• Request additional clinicals as needed.
• Review clinicals received and ensure it meets insurance clinical guidelines for authorization.
• Monitoring of pending cases for approval or denials
• Make necessary follow-ups on insurance and clinics on pending/denied cases.
• Take action on pending cases if it requires additional clinicals, CPT recommendations, and among others.
• Notification to the provider or medical assistant for pending or denied cases.
• Other tasks as given by an immediate superior.

Job Qualifications

Qualifications

• At least 2nd-year level/Graduate/Postgraduate/ Doctorate degree in Life Sciences
• With at least 6 months and above experience in obtaining Pre-Authorization in a healthcare environment.
• Knowledgeable in CPT codes and DX codes
• Familiar with different insurance portals and websites