Prior Authorization Specialist & Surgical Scheduler

CF Solutions Philippines Inc.; Philippines; On-site; PHP 300,000 - 420,000; Full time

Job summary

CF Solutions Philippines Inc. is seeking a Pri or Authorization Specialist & Surgical Scheduler to secure insurance approvals and coordinate patient procedures in the Philippines.

You will liaise with providers, insurers, ASCs and hospitals to ensure timely authorizations, accurate scheduling, and seamless patient care coordination.

Qualifications

• Bachelor’s degree related to healthcare preferred.
• At least 1 year of end-to-end Prior Authorization experience.
• At least 6 months in surgical scheduling or ASC coordination.
• Strong understanding of commercial insurance, Medicare, Medicaid, workers’ compensation, and auto claims.
• Familiarity with HIPAA and healthcare compliance standards.

Responsibilities

• Obtain and manage prior authorizations for surgical and medical procedures.
• Verify insurance requirements and ensure documentation is submitted accurately.
• Follow up with insurers on authorization status and resolve coverage issues.
• Assist with denied claims relating to authorization and support appeals.
• Communicate approvals, denials, and requirements to providers and staff.
• Schedule surgical procedures at hospitals and ASCs.
• Coordinate procedure dates with surgeons, facilities, patients, and partners.
• Prepare and submit surgical booking forms and resolve scheduling discrepancies.
• Manage schedule changes, cancellations, and confirmations.
• Maintain accurate patient records and scheduling documentation.

Skills

Prior Authorization

Surgical Scheduling

Insurance knowledge

HIPAA compliance

Medical records management

Education

Bachelor's Degree in Healthcare Administration / related field

Job description

About the role

The Prior Authorization Specialist & Surgical Scheduler is responsible for securing insurance authorizations and coordinating surgical and procedural scheduling for patients. This role serves as a critical liaison between providers, patients, insurance companies, ambulatory surgery centers (ASC), hospitals, and other healthcare partners to ensure timely authorizations, accurate scheduling, and seamless patient care coordination.

Key responsibilities

• Obtain and manage prior authorizations for surgical and medical procedures
• Verify insurance requirements and ensure all necessary documentation is submitted accurately
• Follow up with insurance carriers on authorization status and resolve coverage issues
• Assist with denied claims related to authorization and support appeals when needed
• Communicate authorization approvals, denials, and requirements to providers and staff
• Schedule surgical procedures at hospitals and ambulatory surgery centers (ASCs)
• Coordinate procedure dates with surgeons, facilities, patients, and other healthcare partners
• Prepare and submit surgical booking forms and resolve scheduling discrepancies
• Manage schedule changes, cancellations, and procedure confirmations
• Maintain accurate patient records and scheduling documentation

About you

• Bachelor's Degree in Healthcare Administration, Medical Office Administration, Health Information Management, Business Administration, or a related field is preferred
• At least 1-year end-to-end experience in Prior Authorization
• At least 6 months experience in surgical scheduling, ambulatory surgery center (ASC) coordination, hospital scheduling, or specialty medical practices such as orthopedics, spine, neurosurgery, pain management, ENT, or general surgery
• Solid understanding of commercial insurance, Medicare, Medicaid, workers' compensation, and automobile accident claims
• Familiarity with prior authorization requirements, payer guidelines, revenue cycle processes, healthcare compliance standards, HIPAA regulations, and surgical scheduling procedures within hospital and ambulatory surgery center environments