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Authorization Specialist – Managed Care
Location
Philippines
Posted
17 days ago
Salary
0
Seniority
Senior
Job Description
Authorization Specialist – Managed Care
Limitlessli
• Obtain initial and continued stay authorizations from Managed Care Organizations (MCOs), Medicare Advantage plans, and other third-party payers • Monitor authorization status, track expiration dates, and submit timely extension requests to prevent coverage gaps • Collaborate with nursing, therapy, admissions, and case management teams to gather clinical documentation required for authorization requests • Maintain accurate authorization records and supporting documentation within the facility's systems • Communicate with insurance companies regarding authorization determinations, requests for additional information, and coverage updates • Review payer requirements and ensure compliance with authorization guidelines and policies • Escalate authorization denials and coordinate with appropriate teams to support reconsiderations or appeals • Assist in identifying authorization-related trends, issues, and opportunities for process improvement • Support revenue cycle objectives by helping ensure services are authorized and reimbursable
Job Requirements
- Minimum 3–4 years of experience in healthcare insurance authorization, utilization review, managed care, admissions, or related healthcare revenue cycle functions
- Experience working with Skilled Nursing Facilities (SNFs), rehabilitation services, long-term care, or post-acute care settings preferred
- Knowledge of Managed Care, Medicare Advantage, Medicaid Managed Care, and commercial insurance authorization processes
- Strong understanding of medical terminology and clinical documentation requirements
- Excellent organizational skills with the ability to manage multiple authorizations and deadlines simultaneously
- Strong verbal and written communication skills
- Proficiency with electronic health records (EHRs), payer portals, and Microsoft Office applications
- Ability to work independently while collaborating effectively with interdisciplinary teams
Benefits
- Essential tools – a reliable computer and noise-canceling headset
- A second monitor for enhanced productivity
- A stable internet connection
- Backup internet connection for seamless work
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