Prior Authorization and Verification

Our Clients; Philippines; On-site; PHP 360,000 - 720,000; Full time

Job summary

Our Clients in Bridgetowne, Quezon City, onsite overnight shift seeks an experienced Account Specialist for the Patient Access – Benefits & Authorization team. You will supervise daily insurance verification, benefits review and authorization workflows, coaching a team while ensuring accuracy and payer alignment.

Applicants should have 3–5 years in patient access or revenue cycle, strong knowledge of CPT/ ICD-10 and EHR systems, and excellent leadership and communication skills.

Qualifications

• High School Diploma or equivalent; Associate's or Bachelor's degree preferred.
• 3–5 years of experience in Patient Access, Insurance Verification, Benefits, referrals, authorizations or Revenue Cycle.
• Solid knowledge of verification, benefits interpretation, authorizations, payer requirements and patient financial responsibility.
• Familiarity with CPT, ICD-10, medical terminology, payer guidelines.
• Proficiency in EHR systems, eligibility tools, pre-certification platforms and reporting tools.

Responsibilities

• Supervise daily operations involving verification, benefits review, registration, referrals, authorization support and patient financial workflows.
• Monitor team productivity, quality, and service levels and provide coaching and feedback.
• Act as SME on payer requirements, eligibility, referrals, authorizations and network status.
• Review team documentation for accuracy and compliance.
• Handle escalated inquiries from patients, providers, payers and internal teams.
• Collaborate with Front Office, Clinical, Revenue Cycle and leadership to improve workflows.
• Support staffing, workload balancing, process improvement and QA initiatives.
• Prepare operational and performance reports for leadership.
• Ensure compliance with policies, payer requirements, privacy and regulations.

Skills

Leadership

Communication

Organizational

Analytical

Problem-solving

Coaching

Conflict resolution

Workflow improvement

Time management

Education

Healthcare Administration

Bachelor's preferred

Tools

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