Remote Healthcare Authorization Specialist

FGC+; Davao City; Remote; PHP 279,000 - 391,000; Full time

Job summary

FGC+ in the Philippines is seeking an Authorization Specialist to support patients, providers, and insurers from home in Davao. You will review clinical documentation, initiate authorizations, and secure medical necessity approvals to ensure timely care.

You will handle daily authorization requests, follow up with insurance portals, prepare appeals, and maintain accurate records while collaborating with clinicians and insurers.

Qualifications

• At least 6 months of BPO experience in a healthcare account or medical-related field.
• Preferably with experience in Pre-Authorization, Utilization Review, or Case Management.
• Strong probing, critical-thinking, and problem-solving skills to assess clinical information and address authorization concerns effectively.
• Ability to read, understand, and identify relevant information from medical records and clinical documentation.

Responsibilities

• Manage and process daily authorization requests from healthcare providers and facilities, ensuring timely and accurate completion.
• Initiate authorization requests through various insurance portals and direct communication with insurance companies.
• Follow up on pending authorizations, track their status, and address any delays or concerns.
• Prepare and process appeals for denied authorization requests.
• Advocate for patients and providers by coordinating with insurance companies to secure approvals across different levels of care.
• Collaborate with healthcare providers to obtain necessary documentation and clarify medical necessity requirements.
• Respond to inquiries from insurance companies, document relevant information, and communicate updates to providers.
• Review and interpret medical records to identify relevant clinical information needed for authorization requests.
• Maintain accurate account records and update documentation in accordance with client guidelines and established processes.
• Ensure all required forms, logs, and reports are completed accurately, thoroughly, and on time.

Skills

BPO experience in healthcare

Healthcare account experience

Critical thinking

Communication

Attention to detail

Organizational skills

Independent work

Tools

MS Word

Excel

PDF tools

Job description

FGC+ in the Philippines is seeking an Authorization Specialist to support patients, providers, and insurers from home in Davao. You will review clinical documentation, initiate authorizations, and secure medical necessity approvals to ensure timely care.

You will handle daily authorization requests, follow up with insurance portals, prepare appeals, and maintain accurate records while collaborating with clinicians and insurers.