Prior Authorization Expert - Healthcare Revenue Cycle

Connext Global Solutions Inc; Davao City; On-site; PHP 279,000 - 502,000; Full time

Benefits offered by this job

Night differential 25%

Life insurance

HMO insurance

Great company culture

Perfect Attendance Bonus

Competitive compensation

Job summary

Connext Global Solutions Inc in Davao is seeking a Prior Authorization Specialist to verify patient insurance benefits, obtain referrals and authorizations, and ensure accurate information before scheduled medical services. You will coordinate with insurers, internal teams, and patients to clarify coverage and financial responsibilities.

The role emphasizes timely submission of authorization requests, proactive tracking of denials, and support for patients through Good Faith Estimates and

Qualifications

• Minimum of two (2) years of healthcare billing experience or healthcare revenue cycle, ICD-10, account receivable and insurance appeals process.

Responsibilities

• Verify, update, and enter insurance information into the electronic practice management system, including policy information, benefit coverage, and referrals.
• Identify potential non-coverage issues and communicate them to patients.
• Review scheduling reports for completeness of insurance information and for the need for referrals, pre-certifications, and prior authorizations, to ensure reimbursement at the highest level possible.
• Submit prior authorization requests and supporting documentation for upcoming appointments with sufficient lead time to obtain authorizations before patients' appointments.
• Submit urgent prior authorization requests as needed.
• Maintain a tracking tool for denied and active prior authorizations, including expiration dates, to anticipate authorizations that need renewal.
• Register patients for support programs and identify delinquent patient accounts that may be eligible for them.
• Create and send Good Faith Estimates to patients, including self-pay patients, based on benefits verification.
• Respond to voicemail and email inquiries from members of the revenue cycle and operations teams in a timely manner.
• Provide feedback to scheduling staff or business office staff on necessary waivers or special instructions.
• Communicate with patients regarding insurance coverage, injection treatments, payment plans, and support programs.
• Maintain up-to-date reference guides and payer requirements.
• Participate in regular team meetings and provide positive feedback and suggestions

Skills

Healthcare billing

Revenue cycle

ICD-10

Insurance coordination

Tools

Practice management system

Job description

Connext Global Solutions Inc in Davao is seeking a Prior Authorization Specialist to verify patient insurance benefits, obtain referrals and authorizations, and ensure accurate information before scheduled medical services. You will coordinate with insurers, internal teams, and patients to clarify coverage and financial responsibilities.

The role emphasizes timely submission of authorization requests, proactive tracking of denials, and support for patients through Good Faith Estimates and