Prior Authorization Specialist

Tahche Outsourcing Services Inc; Cebu City; On-site; PHP 35,000 - 50,000; Full time

Job summary

Tahche Outsourcing Services Inc is seeking a Prior Authorization Specialist to work full-time on a US shift from the office. You will be responsible for obtaining pre-certifications for procedures and medications, scheduling outpatient tests, and managing patient calls.

Ideal candidates should have at least a 2nd-year level degree in Life Sciences, along with experience in the healthcare domain. Strong communication skills and knowledge of CPT codes are essential for this role.

Qualifications

• At least 6 months of experience in obtaining Pre-Authorization in a healthcare environment.
• Knowledgeable in CPT codes and DX codes.
• Familiar with different insurance portals and websites.

Responsibilities

• Responsible for day-to-day monitoring of the Radiology Worklist.
• Sorting of cases based on priority.
• Calling out to Insurance Companies for verification, referrals, and authorization process.
• Case creation in eviCore or another Insurance Portal as required.
• Request additional clinicals as needed.
• Review clinicals received and ensure it meets guidelines.
• Monitoring of pending cases for approval or denials.
• Make necessary follow-ups on pending/denied cases.
• Notification to the provider or medical assistant for pending or denied cases.

Skills

Good verbal and written communication

Detail Oriented

Good understanding of the Pre-Certification Process

Education

2nd-year level/Graduate/Postgraduate/Doctorate degree in Life Sciences

Tools

eviCore

Job description

Our US partner is one of the leading Medical Digital Imaging Service Providers in New Jersey. They offer a full spectrum of diagnostic imaging services in comfortable, convenient, and friendly outpatient imaging centers.

As a Prior Authorization Specialist, you are responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribing and triaging patient calls to physicians, and coordinating patient appointments/orders.

This is a full-time role, on a US shift and on a work-from-the-office set-up.

If you have the right skill set, this may be your opportunity to enter this fast-growing organization.

DUTIES AND RESPONSIBILITIES:

• Responsible for day-to-day monitoring of the Radiology Worklist.
• Sorting of cases based on priority.
• Calling out to Insurance Companies for insurance verification, referrals, and the authorization process.
• Case creation in eviCore or another Insurance Portal as required.
• Request additional clinicals as needed.
• Review clinicals received and ensure it meet insurance clinical guidelines for authorization.
• Monitoring of pending cases for approval or denials
• Make necessary follow-ups on insurance, clinics on pending/denied cases.
• Take action on pending cases if it require additional clinicals, CPT recommendations, and among others.
• Notification to the provider or medical assistant for pending or denied cases.
• Other tasks as given by an immediate superior.

QUALIFICATIONS:

• At least a 2nd-year level/Graduate/Postgraduate/ Doctorate degree in Life Sciences
• With at least 6 months of experience in obtaining Pre-Authorization in a healthcare environment.
• Knowledgeable in CPT codes and DX codes
• Familiar with different insurance portals and websites

ESSENTIAL SKILLS:

• Good verbal and written communication
• Detail Oriented
• Good understanding of the Pre-Certification Process