Prior Authorization Coordinator (Project Base)

iSupport Worldwide; Pasig; On-site; PHP 391,000 - 614,000; Full time

Benefits offered by this job

Free lunch and snacks

Onsite gym with instructor

Annual fitness challenge with PHP 70,0

Free upskilling academy

State-of-the-art facilities

Sleeping quarters and game/chat/shower

Job summary

iSupport Worldwide in Pasig, Metro Manila, is seeking an experienced healthcare admin professional to manage prior authorizations, verifications, and pre-op documentation for four providers.

You will submit PA requests for MAC and light anesthesia, verify eligibility and COB across various payers, and gather documentation to prove medical necessity while ensuring HIPAA and PHI compliance.

Qualifications

• Prior healthcare-related administrative experience.
• Experience with EMR/EHR; familiarity with eClinicalWorks (eCW) is a strong advantage.
• Ability to compile and submit clinical documentation to satisfy medical necessity criteria.

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.

Skills

Attention to detail

Insurance verification

Prior authorization

HIPAA compliance

Multitasking

Overnight shift

Education

Healthcare admin experience

Tools

EMR/EHR

eClinicalWorks (eCW)

CPT ICD-10 coding

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