Back Office Support

Prior Authorization Staff

The Prior Authorization Staff plays a crucial role in ensuring timely and accurate authorization for patient infusions. This position requires meticulous attention to detail, effective communication skills, and a commitment to patient advocacy. The successful candidate will be responsible for submitting clinical information, following up on denials, coordinating with pharmacies, and monitoring infusion schedules to ensure all necessary authorizations are in place.

Job Details:

• Work from Home
• 08:00 AM - 05:00 PM EST (08:00 PM - 05:00 AM Manila Time)

Responsibilities:

• Submit accurate clinical information to obtain prior authorization for patient infusions.
• Follow up on denials by submitting appeals and scheduling peer-to-peer discussions when necessary.
• Review and submit prescriptions to pharmacies in accordance with prior authorization requirements.
• Monitor infusion schedules and confirm that all required authorizations are on file prior to patient appointments.
• Collaborate with healthcare providers and insurance companies to ensure seamless authorization processes.
• Utilize CoverMyMeds software efficiently to streamline prior authorization procedures and enhance productivity.
• Maintain detailed records of authorization activities and communicate updates to relevant stakeholders as needed.

Qualifications:

• Previous experience in medical prior authorization is required.
• Familiarity with CoverMyMeds software is advantageous.
• Strong organizational skills and attention to detail are essential.
• Excellent communication and interpersonal abilities.
• Ability to work independently and prioritize tasks effectively.
• Knowledge of healthcare regulations and insurance policies related to prior authorization processes.

by Carl Trinidad

Prior Authorization Specialist

Job Summary:

We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our growing team. In this role, you will be responsible for verifying insurance eligibility, obtaining prior authorization for medical services, and ensuring that all necessary documentation is in place for accurate billing. The successful candidate will possess excellent communication and organizational skills, as well as the ability to work independently and as part of a team.

Job Details:

• Prior Authorization Specialist
• Work from home
• Monday to Friday | 8 PM to 5 AM Manila Time
• *Following US Holidays

Responsibilities:

• Verify insurance eligibility and benefits for patients, ensuring all information is accurate and up to date.
• Obtain prior authorizations for medical services, working closely with healthcare providers, insurance companies, and patients.
• Maintain thorough and accurate records of all prior authorization requests, approvals, and denials.
• Communicate effectively with healthcare providers, patients, and insurance companies to resolve any issues related to prior authorizations and insurance verification.
• Monitor and track prior authorization statuses, following up as needed to ensure timely processing and approval.
• Collaborate with other team members, including medical billers and coders, to ensure efficient and accurate billing processes.
• Stay informed on the latest changes and updates to insurance policies, procedures, and regulations, applying this knowledge to the prior authorization process.

Qualifications:

• Minimum of 2 years experience in medical insurance verification, prior authorization, or a related role
• Familiarity with medical terminology, diagnostic codes (ICD-10), and procedure codes (CPT)
• Knowledge of insurance policies, procedures, and regulations, including Medicare, Medicaid, and private insurance companies
• Strong computer skills, including proficiency in Microsoft Office Suite.
• Excellent verbal and written communication skills, with the ability to effectively communicate with healthcare providers, patients, and insurance companies.
• Strong organizational skills and attention to detail, with the ability to manage multiple tasks and prioritize effectively.
• Ability to work independently and as part of a team in a fast-paced, deadline-driven environment.
• Experience working with electronic health record (EHR) systems, medical billing software, and insurance verification tools.

by Carl Trinidad

Medical Insurance Collector

Position Summary:

The Medical Insurance Collector is responsible for managing accounts receivable (A/R) to ensure timely and accurate payment from insurance carriers. This role focuses on resolving outstanding claims, handling denials and rejections, and ensuring compliance with insurance guidelines and regulations. The ideal candidate will have experience with insurance portals, appeals, and gastroenterology billing, as well as the ability to work collaboratively in a team environment.

Job Details:

Medical Insurance Collector

Work from Home

Monday to Friday | 9 PM to 6 AM (PH Time)

*Following US Holidays

Responsibilities:

• Work on outstanding A/R to secure payments from insurance carriers.

• Utilize insurance web portals to upload appeals and supporting documents.

• Analyze and interpret Explanation of Benefits (EOBs) to identify payment discrepancies.

• Ensure claims are reimbursed at the correct contracted rates.

• Address and resolve claim rejections and denials efficiently to expedite payment.

• Prepare and submit detailed appeals to insurance carriers when necessary.

• Maintain a thorough understanding of insurance carrier guidelines, including those for government and commercial payers.

• Collaborate with the billing team to meet department goals and deadlines.

Qualifications:

• Minimum of two (2) years’ experience in medical billing and collections.

• Familiarity with GMed software and gastroenterology billing processes is an advantage.

• Comprehensive knowledge of insurance guidelines, regulations, and payer-specific products.

• Proficiency in reading and interpreting EOBs.

• Demonstrated ability to work effectively with government and commercial payers.

• Strong skills in writing and submitting appeals.

• Ability to work effectively in a collaborative, team-oriented environment.

by Carl Trinidad