RN-Powered Prior Authorization Specialist

HRTX; Philippines; On-site; PHP 391,000 - 614,000; Full time

Job summary

HRTX seeks a detail-oriented Prior Authorization Specialist (PHRN) to obtain approvals for procedures, tests, and medications. You will liaise between providers, patients, and payers to minimize delays and ensure timely authorizations, with strong emphasis on accurate documentation and payer policy awareness.

The role requires an active PHRN license and experience in clinical authorization or utilization review, with proficiency in EPIC, MCG, or InterQual guidelines to support efficient

Qualifications

• Must possess an active PHRN license.
• Experience as a Quality Auditor in Clinical Services within a healthcare BPO is preferred; or 4–7 years in Clinical Authorization or Utilization Review.

Responsibilities

• Obtain prior authorizations for procedures, tests, and medications from insurance providers.
• Submit authorization requests to payers and follow up on approvals.
• Maintain complete and compliant documentation in the EHR.
• Respond to payer inquiries and communicate updates to patients.
• Appeal denied requests when appropriate and monitor payer policy changes.

Skills

Attention to detail

Organized

Communication skills

Tools

EPIC

MCG guidelines

InterQual guidelines

Job description

HRTX seeks a detail-oriented Prior Authorization Specialist (PHRN) to obtain approvals for procedures, tests, and medications. You will liaise between providers, patients, and payers to minimize delays and ensure timely authorizations, with strong emphasis on accurate documentation and payer policy awareness.

The role requires an active PHRN license and experience in clinical authorization or utilization review, with proficiency in EPIC, MCG, or InterQual guidelines to support efficient