Prior Authorization Coordinator

• Submit prior authorization requests and secure approvals for pain procedures
• Verify patient insurance coverage, including coordination of benefits (COB), ensuring submissions are sent to the correct payor
• Review medical policies to identify insurance trends and ensure all submissions meet medical necessity criteria with correct CPT codes, levels, and laterality
• Maintain submission documentation and NAR (No Authorization Required) notifications in the patient's chart, including benefits and eligibility
• Compile and submit all relevant clinical documentation, including physical therapy and imaging reports, to insurance for approval
• Confirm insurance benefits and identify patient financial responsibility, including copays and coinsurance, during the PA process
• Update and monitor tracking systems (CRM) with authorization status and procedure details
• Schedule approved procedures
• Communicate with providers regarding discrepancies in orders and attend to provider emails promptly
• Review patient medical records to identify factors impacting procedure, specifically identifying if the patient is taking blood thinners during the PA process
• Review denial letters thoroughly and submit appeals when necessary to overturn insurance decisions
• Coordinate with internal departments on requests affecting authorizations or billing claims
• Follow U.S. HIPAA guidelines for Security and PHI

Requirements

• Experience with U.S. insurance plans, including Medicare, Medicaid, HMOs, PPOs, Workers' Compensation, and MVAs
• Knowledge of payor contractual terms, medical terminology, anatomy & physiology, and ICD-10 and CPT/HCPCS coding
• Strong communication skills to resolve authorization and verification issues with staff, providers, and patients
• High level of attention to detail and quality of work, with the ability to work independently with minimal supervision
• Reliable attendance to support smooth operations

Benefits

• Free lunch meal, fruits, snacks, and drinks (if you are in an onsite shift)
• Onsite gym with a free professional instructor
• Weekly fitness activity and an annual fitness challenge where you can win up to 70,000 PHP
• Weekly engagement activities with prizes that are up to 3,000 PHP
• Free upskilling academy to improve your performance and skillset
• State-of-the-art facilities from toilets to your workstation
• Amenities such as sleeping quarters, game area, chat room, shower room