Prior Authorizations Specialists

Virtuale Staffing; Cebu City; On-site; PHP 290,000 - 469,000; Full time

Job summary

Virtuale Staffing is seeking an experienced Prior Authorization Specialist to verify insurance eligibility and obtain authorizations for medications and procedures. You will track pending approvals, communicate status to care teams, and document all actions in the EHR to ensure timely and accurate patient care.

The ideal candidate has at least 2 years of experience in surgery/prior authorizations, familiarity with US healthcare and insurance, and strong communication and organizational skills to

Qualifications

• Minimum 2 years of experience in surgery/prior authorizations.
• Familiar with US healthcare and insurance processes.
• Excellent verbal and written communication skills.
• Strong organizational and time management abilities.

Responsibilities

• Verify patient insurance eligibility and benefits before scheduled appointments or procedures.
• Obtain prior authorizations for medications, imaging, and procedures via payor portals, fax, or phone.
• Track and follow up on pending authorizations to ensure timely approval.
• Process denial appeals by compiling supporting clinical documentation and submitting reconsideration requests.
• Communicate approval status and next steps to providers and care coordinators.
• Document all actions in the EHR and maintain accurate records of interactions and outcomes.

Skills

Communication

Time management

Organizational skills

Job description

Job Description:

• Verify patient insurance eligibility and benefits before scheduled appointments or procedures
• Obtain prior authorizations for medications, imaging, and procedures via payor portals, fax, or phone
• Track and follow up on pending authorizations to ensure timely approval
• Process denial appeals by compiling supporting clinical documentation and submitting reconsideration requests
• Communicate approval status and next steps to providers and care coordinators
• Document all actions in the EHR and maintain accurate records of interactions and outcomes

Qualifications:

• Must have a minimum of 2 years of experience in surgery/procedure prior authorizations
• Knows about handling and working with US Healthcare and Insurance
• Excellent verbal and written communication skills
• Strong organizational and time management abilities