PHRN Specialist (Healthcare Account)
Full-time
Lennor Group
Location: Pasig, Philippines Work Setup: Onsite Compensation Flexibility: Open to negotiation for highly qualified candidates. Key Responsibilities
- Coverage & Access
- Conduct outbound calls to payers for benefit verifications, prior authorizations, non-formulary exceptions, appeals, and bridge eligibility checks.
- Contact patients directly when needed to facilitate coverage resolution.
- Accurately document all interactions and update case records in a timely manner.
- Follow job aids, case workflows, and escalation protocols.
- Meet established SLAs, KPIs, productivity, and quality standards.
- Identify and report adverse events in accordance with compliance requirements.
- Manage cases across the patient journey, including insurance navigation and financial assistance support.
- Respond promptly to inquiries across phone, chat, email, SMS, fax, and other channels.
- Conduct conference calls with payers and patients to resolve access barriers.
- Ensure proper triage, follow-up, and case escalation when necessary.
- Collaborate with internal stakeholders and contribute to process improvements.
- Utilize technology and documentation systems efficiently to support case management.
- Active Philippine Registered Nurse (PHRN) license.
- Minimum of two (2) year of acute hospital clinical experience.
- Proven experience working in a US Healthcare BPO setting.
- Strong verbal and written communication skills.
- Ability to work efficiently in a fast-paced, high-pressure environment.
- Detail-oriented with strong organizational and documentation skills.
- Demonstrates professionalism, accountability, and adaptability.
- Willing to work onsite in Ortigas.
- Amenable to a fixed night shift schedule.
Vacancy posted 1 day ago
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