Prior Authorization and Eligibility Checker | Work From Home

Vector Outsourcing Solutions Philippines; Mandaluyong; Remote; PHP 335,000 - 446,000; Full time

Benefits offered by this job

Equipment provided

Work from home

Job summary

Vector Outsourcing Solutions Philippines seeks a Remote Prior Authorization Specialist to process referrals and monitor requests using the EHR Scheduling Module. You will verify insurance coverage and coordinate with physicians, carriers, and patients.

Requirements include a Bachelor's degree, 1+ year Prior Authorization experience, excellent English, night-shift readiness, and reliable internet; equipment is provided and you’ll work from home.

Qualifications

• Bachelor's degree required
• 1+ year Prior Authorization experience preferred
• Excellent English communication (written and spoken)
• Ability to prioritize and organize multiple tasks
• Strong customer-centric approach
• Willing to work night shifts and remote setup

Responsibilities

• Receive and monitor prior authorization requests using the EHR Scheduling Module or by phone/fax.
• Process referrals and submit medical records to insurance carriers to expedite approvals.
• Review patient medical history and insurance coverage for eligibility.
• Manage correspondence with insurers, physicians, specialists, and patients; document in the EHR.
• Assist with documentation to expedite approvals and ensure proper follow-up.
• Verify information completeness and ensure required documents are present.
• Follow client procedures and policies; perform other related duties as assigned.

Skills

English communication

Time management

Customer focus

Remote work

Night shift

Education

Bachelor's degree

Tools

EHR Scheduling Module

Job description

Salary

30,000- 40,000 PHP/ month

Job Description

• Receive requests for prior authorizations using the Scheduling Module of the Electronic Health Record (EHR) and/or via phone or fax and ensure that they are closely monitored.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Review the patient's medical history and insurance coverage for approval.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
• Assist with the necessary documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
• Follow team and/or client's proper procedures, policies, and methodologies as instructed.
• Performs other related duties as necessary or assigned

Job Description

• Receive requests for prior authorizations using the Scheduling Module of the Electronic Health Record (EHR) and/or via phone or fax and ensure that they are closely monitored.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Review the patient's medical history and insurance coverage for approval.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
• Assist with the necessary documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
• Follow team and/or client's proper procedures, policies, and methodologies as instructed.
• Performs other related duties as necessary or assigned

Eligibility and Benefits Verification

• Verify insurance eligibility for new and established patients by contacting insurance companies and using online verification systems.
• Review insurance plans to ensure proper coverage for Senior/Elder Care (e.g., wellness visits, screenings, and vaccinations).
• Confirm patient benefits, co-pays, deductibles, and any specific requirements or limitations for Senior Care.
• Provide patients with detailed information regarding their coverage, including potential out-of-pocket costs.

Minimum Qualifications

• Graduate of Bachelor's Degree (preferably in Medical, but not required)
• Consultancy basis minimum of 6 months consultancy contract (subject for renewal)

• At least 1 year of background with Prior Authorization under a BPO healthcare account is an advantage
• Must have excellent English communication skills, both written and oral
• Ability to prioritize and organize multiple tasks
• Strong communication skills and customer centric
• Willing to work in shifting schedules, mostly night shift
• Able to work from home, must have a reliable internet connection

Others

• Equipment/ company computer is provided
• Work from Home