Prior Authorization Specialist

Virtual Staffing Solutions; Merida; On-site; PHP 180,000 - 360,000; Full time

Job summary

Virtual Staffing Solutions is seeking a meticulous Prior Authorization Follow-Up Specialist in the Philippines. You will manage and monitor submitted authorization requests by communicating directly with insurance payers to secure timely decisions, resubmitting any missing documentation as needed.

In this role you will navigate payer systems, document outcomes, and coordinate with internal teams to keep patient care on track while maintaining accurate records and meeting deadlines.

Qualifications

• Previous experience in healthcare administration, prior authorization, medical billing, or insurance verification preferred.
• Familiarity with insurance payers, authorization processes, and healthcare terminology.
• Strong verbal communication and telephone skills.
• Ability to navigate complex phone systems and manage multiple follow-up tasks.
• Excellent attention to detail and organizational skills.
• Proficiency in reviewing and interpreting medical or authorization documentation.

Responsibilities

• Contact insurance payers to follow up on submitted prior authorization requests and actively work toward obtaining authorization decisions.
• Navigate automated phone systems, call queues, and hold lines to reach appropriate payer representatives.
• Review prior authorization submissions and supporting documentation before and during payer calls to accurately address questions and provide additional information as needed.
• Identify cases where documentation has not been received by the payer and promptly resend or refax required materials.
• Confirm receipt of resubmitted documentation with payer representatives to ensure successful processing.
• Document call outcomes, authorization statuses, and any additional requirements or next steps.
• Communicate payer feedback, outstanding requirements, and authorization updates to internal teams.
• Maintain organized records of authorization activities and follow-up efforts.
• Escalate unresolved issues or delayed cases as appropriate to support timely patient care and operational efficiency.

Skills

Communication skills

Telephone skills

Attention to detail

Organization

Job description

Merida, Merida, Leyte, Eastern Visayas, Philippines

0 - 2 Years

REGULAR

Job Description

The Prior Authorization Follow-Up Specialist is responsible for managing and monitoring submitted prior authorization requests by communicating directly with insurance payers. This role ensures timely processing of authorization s, addresses payer inquiries, and facilitates the resubmission of required documentation to support approval decisions.

Key Responsibilities

• Contact insurance payers to follow up on submitted prior authorization requests and actively work toward obtaining authorization decisions.
• Navigate automated phone systems, call queues, and hold lines to reach appropriate payer representatives.
• Review prior authorization submissions and supporting documentation before and during payer calls to accurately address questions and provide additional information as needed.
• Identify cases where documentation has not been received by the payer and promptly resend or refax required materials.
• Confirm receipt of resubmitted documentation with payer representatives to ensure successful processing.
• Document call outcomes, authorization statuses, and any additional requirements or next steps.
• Communicate payer feedback, outstanding requirements, and authorization updates to internal teams.
• Maintain organized records of authorization activities and follow-up efforts.
• Escalate unresolved issues or delayed cases as appropriate to support timely patient care and operational efficiency.

Qualifications

• Previous experience in healthcare administration, prior authorization , medical billing, or insurance verification preferred.
• Familiarity with insurance payers, authorization processes, and healthcare terminology.
• Strong verbal communication and telephone skills.
• Ability to navigate complex phone systems and manage multiple follow-up tasks.
• Excellent attention to detail and organizational skills.
• Proficiency in reviewing and interpreting medical or authorization documentation.