Discover your 100% YOU with MicroSourcing!Position: Insurance Verification and Authorization (IV/Auth) Specialist
Location: Picadilly Star Building, BGC
Work setup & shift: Night Shift & Onsite
Why join MicroSourcing Youu0027ll have:- Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and performance bonuses
- A Collaborative Spirit: Contribute to a positive and engaging work environment by participating in company-sponsored events and activities.
- Work-Life Harmony: Enjoy the balance between work and life that suits you with flexible work arrangements.
- Career Growth: Take advantage of opportunities for continuous learning and career advancement.
- Inclusive Teamwork: Be part of a team that celebrates diversity and fosters an inclusive culture.
Your Role:
The Insurance Verification and Authorization (IV/Auth) Specialist verifies eligibility and initiates and/or follows up on prior authorization requests with insurance companies, providers, and patients in the US. They ensure timely and accurate processing of authorization requests, coordinate with clinical teams, and maintain compliance with payer guidelines and HIPAA standards.
As a an
Insurance Verification and Authorization (IV/Auth) Specialist, you will:
- Insurance Verification
- Verify insurance and benefit eligibility for patient services
- Authorization
- Review clinical documentation and insurance guidelines to determine authorization requirements
- May be responsible for verifying authorizations obtained by provider offices are accurate including correct CPT code, patient demographics, and effective dates cover the scheduled service date
- May be responsible for obtaining authorizations for scheduled services from insurance or third parties as necessary to financially secure services
- Ensure timely submission and follow-up of prior authorization requests to meet turnaround time (TAT) expectations
- Identify and escalate authorization denials or delays in authorization to the appropriate team (e.g., Patient Access, Billing, etc.)
- May be responsible for notification of admission as required by payers
- May need to review medical necessity criteria and payer-specific guidelines
- Payer and Patient outreach and communication
- Perform outbound calls and online inquiries to insurance companies, providers, and patients to verify eligibility and to initiate and follow up on prior authorization requests
- Handle inbound calls from U.S.-based and providers, demonstrating effective communication skills, empathy, and familiarity with healthcare or revenue cycle management processes
- Coordinate with physician offices and clinical teams to obtain missing documentation
- Documentation
- Accurately enter and update authorization, eligibility, benefit, and patient demographic details in the client system (e.g., Epic, Meditech, Cerner)
- Documents all payer communication and account activity according to defined standards
- Maintain high level of confidentiality, professionalism, and compliance with HIPAA and other regulatory standards to protect patient information
- Adhere to the IV/Auth quality and productivity standards established by the organization
Other duties and responsibilities as assigned. What You Need: Non-Negotiables:- Insurance Verification/Authorization Experience: At least one year of US Healthcare industry experience completing insurance verification and authorization activities
- Education: Senior High School Diploma or equivalent
- Software Knowledge: Experience with an electronic medical record (EMR) system (e.g., Epic, Cerner, Meditech, etc.)
- Strong understanding of insurance verification processes and benefit determination
- Familiarity with payer portals and insurance websites for checking authorization and eligibility status
- Proficiency in MS Office Standard Tools (Word, Outlook, Excel, etc.)
Preferred Qualifications:- Education: Masteru0027s degree or credential in business, healthcare, or related field preferred
- Licensure: Registered Nurse and with active PHRN or USRN license preferred.
- Software Knowledge: Current experience utilizing encoding/grouping software and Computer Assisted Coding (CAC) is preferred. Encoder experience (3M/Solventum, Encoder Pro, Codify) preferred. Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, SharePoint) . Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, SharePoint)
- RCM Knowledge: Prior experience with US healthcare providers or payers.
Soft Skills- Demonstrated ability to prioritize amid competing priorities
- Strong ability to analyze raw data, draw conclusions, and develop actionable recommendations
- Proven ability to adapt quickly to new and changing technical environments
- Ability to pay close attention to details strong follow-up and follow-through skills
- Regularly makes complex decisions within the scope of the position, and is comfortable working independently
- Independent judgment, discretion, and decision-making abilities
- Demonstrates teamwork and integrity in all work-related activities
- Ability to interact with internal and external customers in a professional manner
- Strong analytical and critical thinking skills
- Knows, understands, incorporates, and demonstrates Huronu0027s Vision, and Values in behaviors, practices, and decisions
Preferred Qualifications- Authorization Experience: Two or more years of US Healthcare industry experience completing insurance verification and authorization activities
- Education: Philippine bacheloru0027s degree or equivalent preferred
- RCM Knowledge: Knowledge of CPT and ICD-10 coding
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About MicroSourcing With over 9,000 professionals across 13 delivery centers, MicroSourcing is the pioneer and largest offshore provider of managed services in the Philippines.
Our commitment to 100% YOU MicroSourcing firmly believes that our companyu0027s strength lies in our peopleu0027s diversity and talent. We are proud to foster an inclusive culture that embraces individuals of all races, genders, ethnicities, abilities, and backgrounds. We provide space for everyone, embracing different perspectives, and making room for opportunities for each individual to thrive.
At MicroSourcing, equality is not merely a slogan - itu0027s our commitment. Our way of life. Here, we donu0027t just accept your unique authentic self - we celebrate it, valuing every individualu0027s contribution to our collective success and growth. Join us in celebrating YOU and your 100%!
For more information, visit https://www.microsourcing.com/
.Terms & conditions apply
About the Client - Huron
Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and
communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
