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
