Prior Authorization Specialist

MicroSourcing International; Quezon City; On-site; PHP 502,000 - 725,000; Full time

Benefits offered by this job

Healthcare coverage from day 1

Paid time off with cash conversion

Group life insurance

Performance bonuses

Competitive rewards

Job summary

MicroSourcing, a leading outsourcing partner in the Philippines, seeks a Prior Authorization Specialist to process requests for US payer approvals onsite in Eastwood, Quezon City, night shift.

You will verify eligibility, review records, coordinate with providers and insurers, ensure HIPAA compliance, and meet productivity targets. Join a diverse team with competitive rewards and growth opportunities.

Qualifications

• Minimum of 5+ years of experience in Prior Authorization, UM, or RCM.
• Knowledge of US healthcare insurance processes and payer requirements.
• Familiarity with CPT, ICD-10, HCPCS codes.
• Experience using EHR and practice management systems; insurance portals is an advantage.
• Strong written and spoken English.

Responsibilities

• Process and submit prior authorization requests to US health insurance providers.
• Verify patient eligibility, insurance coverage, and authorization requirements.
• Review medical records and supporting documentation for completeness.
• Follow up on pending, approved, and denied requests.
• Coordinate with physicians, offices, and insurers regarding status and requirements.
• Identify missing documentation and complete requirements.
• Maintain accurate records and update statuses in systems.
• Ensure HIPAA compliance and data privacy.
• Meet productivity, quality, and turnaround time targets.

Skills

Prior Authorization

Healthcare RCM

US healthcare processes

HIPAA compliance

Attention to detail

English communication

Independent work

Multitasking

Tools

EHR systems

Practice management systems

Insurance portals

Job description

Discover your 100% YOU with MicroSourcing!

Position: Prior Authorization Specialist

Location: Eastwood, Libis. Quezon City

Work setup & shift: Onsite, Night shift

Why join MicroSourcing?

You'll have:

• Competitive Rewards: Enjoy above-market compensation, healthcare coverage on Day 1 for you and one or more dependents, paid time off with cash conversion, group life insurance, and performance bonuses.
• A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
• Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
• Career Growth: Take advantage of opportunities for continuous learning and career advancement.
• Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.

Your Role:

As Prior Authorization Specialist, you are responsiblefor processing prior authorization requests for medical services, procedures, and medications by coordinating with healthcare providers and insurance companies to ensure timely approvals and compliance with payer requirements.

Specifically, you will:

• Process and submit prior authorization requests to US health insurance providers.
• Verify patient eligibility, insurance coverage, and authorization requirements.
• Review medical records and supporting clinical documentation to ensure completeness.
• Follow up on pending, approved, and denied authorization requests.
• Coordinate with physicians, medical offices, and insurance companies regarding authorization status and requirements.
• Identify missing documentation and facilitate the completion of requirements.
• Maintain accurate records and update authorization statuses in designated systems.
• Ensure compliance with HIPAA guidelines and healthcare data privacy standards.
• Meet established productivity, quality, and turnaround time (TAT) targets.

What You Need:

Non-negotiables

• Minimum of 5+years of experience in Prior Authorization, Utilization Management (UM), or Healthcare Revenue Cycle Management (RCM).
• Knowledge of US healthcare insurance processes, payer requirements, and authorization workflows.
• Familiarity with medical terminology and CPT, ICD-10, and HCPCS codes.
• Experience using Electronic Health Records (EHR), practice management systems, and insurance portals is an advantage.
• Strong verbal and written English communication skills.
• Excellent attention to detail, organizational, and problem-solving abilities.
• Ability to work independently and manage multiple requests in a fast-paced, metrics-driven environment.
• Willingness to work on a night-shift schedule aligned with US business hours.

About MicroSourcing

With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.

Our commitment to 100% YOU

MicroSourcing firmly believes that our company's strength lies in our people's diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives, and making room for opportunities for each individual to thrive.

At MicroSourcing, equality is not merely a slogan – it's our commitment. Our way of life. Here, we don't just accept your unique authentic self - we celebrate it, valuing every individual's contribution to our collective success and growth. Join us in celebrating YOU and your 100%!

For more information, visit https://www.microsourcing.com/

*Terms & conditions apply