Prior Authorization and Verification

PM Consulting; Philippines; On-site; PHP 391,000 - 614,000; Full time

Job summary

PM Consulting in the Philippines is seeking an experienced Account Specialist in Patient Access to lead insurance verification, benefits interpretation, referrals, and authorization support onsite in Bridgetowne, Quezon City during night shift.

You will monitor productivity, coach staff, ensure compliance with payer requirements and privacy rules, and collaborate with Front Office, Clinical, and Revenue Cycle teams to improve workflows.

Qualifications

• Experience in Patient Access, Insurance Verification, and authorizations preferred.
• Knowledge of CPT/ICD-10 and payer medical necessity guidelines.
• Strong leadership and communication skills; able to coach and resolve conflicts.
• Orthopedic experience is strongly preferred.

Responsibilities

• Oversee daily insurance verification, benefits review, referrals, and authorization support.
• Monitor productivity, quality, turnaround times, and service levels.
• Serve as SME on payer requirements, eligibility, and provider participation.
• Ensure accuracy and compliance of team documentation.
• Provide coaching, feedback, and performance development.

Skills

Insurance verification

Benefits review

Authorization support

Team leadership

Coaching

Performance management

Workflow improvement

Payer requirements

Communication

Problem solving

Education

High school diploma or equivalent

Associate's or Bachelor's in Healthcare Administration or related field preferred

Tools

EHR systems

Eligibility tools

Pre-certification platforms

Payer portals

Microsoft Office

Reporting tools

Job description

Prior Authorization, Verification and Eligibility

Location: Bridgetowne, Quezon City
Work Setup: Onsite
Schedule:Night Shift
We are looking for an experienced Account Specialist team under Patient Access – Benefits & Authorization.

Key Responsibilities

• Supervise daily operations involving insurance verification, benefits review, package registration, referrals, authorization support, and patient financial responsibility workflows.
• Monitor team productivity, quality, turnaround times, and service levels.
• Serve as a subject matter expert on payer requirements, eligibility tools, benefit interpretation, referrals, authorizations, network status, and provider participation.
• Review team documentation to ensure accuracy and compliance with established standards.
• Provide coaching, training, feedback, and performance development to team members.
• Handle escalated patient, provider, payer, and internal inquiries.
• Collaborate with Front Office, Clinical, Contact Center, Revenue Cycle, and leadership teams to resolve issues and improve workflows.
• Support staffing coordination, workload balancing, process improvement, and quality assurance initiatives.
• Prepare and communicate operational and performance reports to leadership.
• Ensure compliance with departmental policies, payer requirements, privacy standards, and applicable regulations.

Qualifications

• High School Diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field is preferred.
• At least 3–5 years of experience in Patient Access, Insurance Verification, Benefits, Referrals, Authorizations, Revenue Cycle, physician office, or hospital environments.
• Strong knowledge of insurance verification, benefit interpretation, prior authorization, referral processes, payer requirements, and patient financial responsibility.
• Familiarity with CPT, ICD-10, medical terminology, clinical documentation, and payer medical necessity guidelines.
• Proficiency in EHR systems, eligibility tools, pre-certification platforms, payer portals, Microsoft Office, and reporting tools.
• Strong leadership, communication, organizational, analytical, problem-solving, coaching, and conflict-resolution skills.
• Ability to manage workloads, analyze trends, identify root causes, and implement workflow improvements.
• Orthopedic experience is strongly preferred