Eastwood Libis, QC, PH

Prior Authorization Specialist - Behavioral Health

Position Summary:

We are seeking a detail-oriented and experienced Prior Authorization Specialist - Behavioral Health to join our growing team. In this role, you will be responsible for verifying insurance eligibility, following up on prior authorizations, 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:

  • Work from home
  • Monday to Friday | 9:00 PM to 6:00 AM Manila Time
  • *Following US Holidays

Responsibilities:

  • Monitor, track prior authorization statuses, and follow up on authorization requests to ensure timely processing and approval.
  • Coordinate with facilities and the Utilization Review (UR) team to manage cases.
  • Ensure timely and efficient communication through emails and other correspondence.
  • Verify insurance eligibility and benefits for patients, ensuring all information is accurate and up to date.
  • 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.
  • 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.
  • Other duties as assigned by the management.

Qualifications:

  • Minimum of 2 years' experience in medical insurance verification, prior authorization, or a related role in the US Healthcare Industry.
  • Experience in behavioral health and substance use disorder facilities (PHP and RTC levels of care preferred) is required.
  • 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 and electronic health record systems.
  • Candidates must have excellent written and verbal communication skills and be well-versed in crafting punctual and professional emails.
  • 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

Power Platform Developer

Position Summary:

We are seeking a skilled Power Platform Developer to design, develop, and maintain solutions within the Microsoft Power Platform ecosystem. The ideal candidate will have expertise in Power Apps (Canvas and Model-Driven Apps), Power Automate, Power BI, and Power Virtual Agents, as well as the ability to integrate these solutions with other Microsoft services and third-party applications. This role will involve collaborating with business stakeholders to gather requirements, deliver custom solutions, and ensure that all implementations are scalable, maintainable, and secure. Additionally, you will provide technical support, training, and apply DevOps practices to automate deployment, monitoring, and management of Power Platform solutions.

Job details:

  • Monday to Friday
  • Work from home

Responsibilities:

  • Design, develop, and maintain applications using Microsoft Power Apps (Canvas and Model-Driven Apps).
  • Automate business processes and workflows using Power Automate.
  • Create data visualization and reporting solutions using Power BI.
  • Develop and manage chatbots using Power Virtual Agents.
  • Build and customize Power Pages using JavaScript and other web technologies.
  • Integrate Power Platform solutions with other Microsoft services and third-party applications.
  • Collaborate with business stakeholders to gather requirements and deliver custom solutions.
  • Ensure solutions are scalable, maintainable, and secure.
  • Provide technical support and training to users.
  • Implement and manage SQL databases to support Power Platform solutions.
  • Apply DevOps practices to automate deployment, monitoring, and management of Power Platform solutions.
  • Stay updated with the latest features and updates in the Microsoft Power Platform.

Qualifications:

  • Bachelor’s degree in Computer Science, Engineering, or a related field.
  • Proven experience as a Power Platform Developer or in a similar role.
  • Strong knowledge of Microsoft Power Platform products, including Power Apps, Power Automate, Power BI, and
  • Power Virtual Agents.
  • Proficiency in JavaScript, HTML, and CSS for customizing Power Pages.
  • Experience with relational databases (e.g., SQL Server, Dataverse).
  • Familiarity with Azure services and integrations.
  • Experience with DevOps practices and tools (e.g., Azure DevOps, Git).
  • Strong problem-solving skills and attention to detail.
  • Excellent communication and collaboration skills.

by Carl Trinidad

Optometric Prescription Specialist

Position Summary:

As an Optometric Prescription Specialist, you will play a pivotal role in ensuring the accurate interpretation and effective utilization of optical prescriptions. Your responsibilities encompass analyzing a wide array of prescriptions, and offering concise feedback, and solutions.

Job Summary:

  • Work from home
  • Monday to Friday | 10 PM to 7 AM Manila Time

Responsibilities:

  • Analyze and interpret a wide range of optical prescriptions, providing clear and concise feedback.
  • Provide expert advice and support to non-clinical staff on matters related to optometry and prescriptions.
  • Stay updated on the latest trends and standards in optometry to ensure the highest level of service quality.
  • Liaise with clients to clarify prescription details when necessary, ensuring a high level of customer service.
  • Maintain patient confidentiality and adhere to all HIPAA regulations while handling sensitive information.
  • Collaborate with global teams across various time zones, utilizing digital communication tools effectively.

Qualifications:

  • Doctor of Optometry (O.D.) degree from an accredited optometry program.
  • Valid state license to practice optometry.
  • Minimum of 2 years of experience in a clinical setting, with substantial exposure to reading and interpreting prescriptions.
  • Proficient in the use of digital communication tools and comfortable working in a remote environment.
  • Strong organizational and project management skills to handle training program development.
  • Ability to work independently with minimal supervision and collaborate effectively with a remote team.
  • Exceptional communication and interpersonal skills, with an emphasis on educating non-clinical staff.
  • Previous experience in a BPO setting is advantageous but not required.
  • Customer Service experience is a must

by Carl Trinidad