Prior Authorization Coordinator Project Base

iSupport Worldwide; Manila; On-site; PHP 223,000 - 446,000; Full time

Benefits offered by this job

Free lunch meals

Onsite gym with instructor

Weekly fitness activity

Annual fitness challenge up to 70000 ₱

Gifted upskilling academy

State-of-the-art facilities

Sleeping quarters and game area

Job summary

iSupport Worldwide is seeking an experienced healthcare administrative professional to manage end-to-end prior authorizations, insurance verifications, and pre-operative documentation for four providers. You will submit PA requests for MAC and light anesthesia, verify eligibility, and gather necessary medical records to meet medical necessity criteria.

The role involves scheduling cases in eClinicalWorks (eCW), coordinating post-operative follow-ups for internal providers, and maintaining HIPAA

Qualifications

• Prior healthcare administrative experience, ideally in prior authorization or surgical scheduling.
• Experience with EMR/EHR and familiarity with eCW (strong advantage).
• Ability to compile and submit clinical documentation to satisfy medical necessity criteria.
• Working knowledge of CPT/ICD-10 coding as it relates to PA submissions.

Responsibilities

• Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 assigned providers.
• Submit prior authorization requests for MAC and light anesthesia procedures accurately and promptly.
• Verify patient eligibility, coverage, and COB across commercial payers, Medicare, Medicaid, HMOs, PPOs, Workers Comp, and MVA.
• Gather clinical documentation and diagnostic imaging to satisfy medical necessity criteria.
• Schedule procedure cases in eCW to maintain adequate anesthesia day coverage across all 4 providers.
• Coordinate post-operative appointments only for the internal provider; omit post-op scheduling for the 3 outside providers who handle their own follow-ups.

Skills

Insurance verification

Attention to detail

PA submissions (surgical cases)

Eligibility & COB checks

Tools

EMR/EHR

eClinicalWorks (eCW)

Job description

Job Description:

Core Responsibilities:

• Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 assigned providers
• Submit prior authorization requests for MAC and light anesthesia procedures accurately and promptly
• Verify patient eligibility, coverage, and COB across commercial payers, Medicare, Medicaid, HMOs, PPOs, Workers Comp, and MVA
• Gather clinical documentation and diagnostic imaging to satisfy medical necessity criteria
• Schedule procedure cases in eCW to maintain adequate anesthesia day coverage across all 4 providers
• Coordinate post-operative appointments only for the internal provider; omit post-op scheduling for the 3 outside providers who handle their own follow-ups
• Maintain compliance with U.S. HIPAA guidelines and PHI protocols

Non-Negotiable:

• Familiarity with insurance verification, benefits, and payer processes
• Strong attention to detail and accuracy
• Experience in healthcare accounts and prior authorization submissions, especially for surgical cases
• Experience checking eligibility, coordination of benefits (COB), deductible, and coinsurance

Required:

• Prior healthcare-related administrative experience, ideally in prior authorization or surgical scheduling
• Experience with electronic medical records (EMR/EHR); familiarity with eClinicalWorks (eCW) is a strong advantage
• Ability to compile and submit clinical documentation to satisfy medical necessity criteria
• Working knowledge of CPT/ICD-10 coding as it relates to PA submissions
• Ability to manage multiple provider accounts and a high-volume pipeline while consistently meeting daily quotas
• Dependability and punctuality, particularly for the assigned overnight shift
• Ability to maintain confidentiality and handle protected patient information appropriately

Preferred / Advantage:

• Prior experience with MAC and light anesthesia surgical procedure authorizations
• Prior experience in a pain management or specialty surgical scheduling setting

• Free lunch meal, fruits, snacks, and drinks
• Onsite gym with a free professional instructor
• Weekly fitness activity and an annual fitness challenge where you can win up to 70,000 PHP
• Weekly engagement activities with prizes that are up to 3,000 PHP
• Free upskilling academy to improve your performance and skillset
• State-of-the-art facilities from toilets to your workstation
• Amenities such as sleeping quarters, game area, chat room, shower room

Requirements: