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 is hiring for a healthcare account specialist to manage prior authorizations, review patient records, and coordinate with insurers to speed approvals. This remote role involves night shifts, requires strong English, multitasking, and attention to detail, with equipment provided.

You will process referrals, submit records, verify benefits and co-pays, and ensure complete documentation according to client procedures.

Qualifications

• Graduate with a bachelor’s degree (medical preferred but not required).
• 6 months consultancy contract minimum (renewal subject).
• 1 year of prior authorization experience in a BPO healthcare account is an advantage.
• Excellent English communication skills, written and spoken.
• Ability to prioritize and organize multiple tasks.
• Strong communication and customer-centric approach.
• Willing to work shifting schedules, mostly night shift.
• Able to work from home with reliable internet.

Responsibilities

• Receive prior authorization requests via EHR Scheduling Module, phone or fax and monitor them.
• Process referrals and submit medical records to insurers to expedite authorization.
• Review patient history and insurance coverage for approval.
• Manage correspondence with insurers, physicians, and patients in the EHR.
• Assist with documentation to expedite approvals and follow-up.
• Check information accuracy and ensure all documents are present.
• Follow client procedures, policies, and methodologies.
• Perform additional related duties as assigned.

Skills

English proficiency

Prior authorization

Multitasking

Communication skills

Customer service

Education

Bachelor's degree

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

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