Prior Authorization Specialist

Hammerjack Pty Ltd; Philippines; On-site; PHP 240,000 - 300,000; Full time

Benefits offered by this job

Competitive compensation

Signing bonus Php 5,000

Life insurance

HMO Insurance

Annual merit increase

Night differential

Onsite location Ortigas

Great company culture

Job summary

Connext Global Solutions is seeking a Prior Authorization Specialist to support a U.S. client from its Ortigas office in the Philippines." The role focuses on verifications and obtaining prior authorizations for a range of therapy services, requiring strong communication and organizational skills.

The candidate will interact with insurers, understand various plan types, and ensure timely processing compliant with insurance requirements.

Qualifications

• Minimum of one year experience with medical billing and/or understanding of benefits including deductibles, co-insurance, out of pocket and benefits exclusions.

Responsibilities

• Conduct insurance verifications and obtain prior authorizations for therapy services (Physical, Occupational, Speech, Autism, Outpatient Behavioral Health).
• Call insurers to collect benefits and confirm authorization status.
• Navigate insurance portals and apply knowledge of CPT coding and billing processes.
• Communicate clearly in English with providers, patients, and insurers.
• Work efficiently under deadlines and manage multiple tasks.

Skills

Phone etiquette

Customer service

English communication

Organizational skills

Multi-tasking

Tools

EMR/EHR systems

PMS (Practice Management Systems)

Insurance portals

Job description

Connext Global Solutions is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.

We are currently looking for an Prior Authorization Specialist who will be working with Connext's Client in the United States of America.

What's in it for you

• Competitive compensation
• Perfect Attendance Bonus
• Life insurance
• HMO Insurance
• Great company culture
• Annual Merit Increase
• 25% Night Differential
• Onsite in Ortigas
• Signing bonus Php 5,000

The Prior Authorization Specialist is responsible for conducting insurance verifications and obtaining prior authorizations for a diverse range of therapy services, including Physical Therapy, Occupational Therapy, Speech Therapy, Autism Therapy, and Outpatient Behavioral Health. This role requires a knowledgeable, organized, and professional individual with excellent communication skills to ensure timely processing and compliance with insurance requirements.

• Phone etiquette and customer service skills, experience calling insurers to collect benefits and confirm authorization status.
• Has understanding with HMOs, PPOs, POSs, EPOs, Medicare, Medicaid through the referral and authorization process.
• Familiarity with navigating insurance portals.
• Demonstrates strong understanding of insurance policies and medical billing processes including CPT coding.
• Work ethic to operate with urgency, work independently, be highly organized, detailed oriented and multi-task effectively.
• Work efficiently under deadlines.
• Clear and coherent both written and verbal communication skills in English.

Required Qualifications:

• Minimum of one (1) year experience with medical billing and/or understanding of benefits including deductibles, co-insurance, out of pocket and benefits exclusions.
• Experience in providers software, including Electronic Medical Record Systems (EMR/EHR) and Practice Management Systems (PMS).
• Must have a stable employment history.