Prior Authorization Specialist — Night Differential & Benefits

Connext Global Solutions Inc; Pampanga; On-site; PHP 614,000 - 837,000; Full time

Benefits offered by this job

Life insurance

HMO Insurance

Perfect Attendance Bonus

Night differential 25%

Job summary

Connext Global Solutions Inc is seeking a Prior Authorization Specialist to secure insurance approvals for medical procedures, services, and medications for a US client. The role combines data entry, benefits verification, and communications with patients.

You will verify insurance information, identify non-coverage issues, submit requests with lead times, track denials, and support providers with documentation and questions.

Qualifications

• Minimum of 1 year in healthcare billing, insurance billing, or prior authorization processes.
• Working knowledge of copays, coinsurance, deductibles, and health insurance benefits.

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 referrals, pre-certifications, and prior authorizations to ensure reimbursement at the highest level
• 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
• 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 revenue cycle and operations teams in a timely manner
• Provide feedback to scheduling staff or business office staff on 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 knowledge

Insurance benefits understanding

Job description

Connext Global Solutions Inc is seeking a Prior Authorization Specialist to secure insurance approvals for medical procedures, services, and medications for a US client. The role combines data entry, benefits verification, and communications with patients.

You will verify insurance information, identify non-coverage issues, submit requests with lead times, track denials, and support providers with documentation and questions.