Prior Authorization Coordinator (Project Base)

iSupport Worldwide; Metro Manila; On-site; PHP 279,000 - 502,000; Full time

Benefits offered by this job

Free meals and snacks

Onsite gym with instructor

Weekly fitness activities

Fitness challenges with PHP bonuses

Upskilling academy

Modern facilities

Sleeping quarters and game/chat areas

Job summary

iSupport Worldwide seeks a detail-oriented healthcare admin specialist to manage end-to-end prior authorizations, verify insurances, and coordinate pre-op documentation for four providers. You will work with EMR/EHR systems, including eClinicalWorks (eCW), and ensure medical necessity criteria are met for surgical cases.

Responsibilities include scheduling in eCW, MAC and light anesthesia PA submissions, COB checks, and maintaining strict confidentiality of Protected Health Information.

Qualifications

• Non-negotiable: familiarity with insurance verification, benefits and payer processes.
• Demonstrated experience in healthcare accounts and PA submissions for surgical cases.
• Experience checking eligibility, COB, deductible and coinsurance.
• EMR/EHR experience; familiarity with eCW is a strong advantage.
• Ability to compile and submit clinical documentation for medical necessity.
• Knowledge of CPT/ICD-10 coding related to PA submissions.
• Ability to manage multiple provider accounts and high-volume workflow.
• Dependability and punctuality, especially for overnight shifts.
• Maintain confidentiality and protect PHI.

Responsibilities

• Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 providers.
• Submit PA requests for MAC and light anesthesia procedures.
• Verify patient eligibility, coverage, and COB across payers.
• Gather clinical docs and imaging to satisfy medical necessity.
• Schedule procedure cases in eCW to ensure anesthesia coverage.
• Coordinate post-operative appointments for internal provider; other providers handle their follow-ups.
• Maintain HIPAA compliance and PHI protocols.

Skills

Insurance verification

Attention to detail

Prior authorization

EMR/EHR experience

eCW familiarity

CPT/ICD-10 coding

HIPAA compliance

Scheduling

Multi-provider management

Confidentiality

Tools

eClinicalWorks (eCW)

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

Requirements

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

Benefits

• 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