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Authorization Specialist, Healthcare
Location
Philippines
Posted
2 days ago
Salary
₱33K - ₱36.5K / month
Seniority
Senior
Job Description
Authorization Specialist, Healthcare
SuperStaff
• Identify patients requiring insurance authorization by auditing patient files and pulling relevant reports. • Submit accurate and timely authorization requests, including additional visit requests, start date modifications, and expiration extensions, while following payer-specific protocols (e.g., ASH, OPAP, Carelon, MDIPA, Highmark, etc). • Use evaluative notes in chronological order, adjusting dates when necessary to support authorization submissions when re-evaluations are missing. • Double-check visit counts and date ranges to prevent gaps or overlaps in authorized care. • Avoid requesting unauthorized codes (e.g., initial evals for ASH) and adhere to insurance-specific submission guidelines. • Document each submission in both the authorization spreadsheet and patient chart, including the number of visits requested, start/end dates, and the DOS of the supporting eval or re-eval note. • Retrieve and upload all authorization responses, including approvals and denials, to patient charts and the appropriate lockboxes; update the auth spreadsheet and sync visits accordingly. Immediately notify the Front Office Coordinator (FOC) and Regional Office Manager (ROM) of any denials to prevent uncovered visits. • Carefully audit charts to ensure authorizations are accurately linked to each date of service (DOS); apply retroactive authorizations as needed using proper syncing protocols.
Job Requirements
- Strong understanding of insurance authorization processes and physical therapy billing requirements.
- High attention to detail and accuracy in data entry, documentation, and tracking.
- Ability to interpret clinical notes and match them to payer requirements.
- Proficiency in navigating EHR systems (e.g., Stride) and payer authorization portals.
- Excellent organizational skills with the ability to manage high volumes of submissions and follow-ups.
- Clear written communication skills for documentation and interdepartmental updates.
- Discretion and professionalism in handling confidential patient and payer information.
- Familiarity with physical therapy terminology and clinical documentation standards.
- Strong time management skills to meet payer deadlines and internal timelines.
- Ability to follow detailed instructions and collaborate with clinical, billing, and administrative teams.
Benefits
- HMO with 1 free dependent upon hire
- Life Insurance
- Night Differential
- 20 PTO credits annually
- VL and SL cash conversion
- Annual Performance-Based Merit Increases and Employee Recognition
- Great Company Culture
- Career Growth and Learning
- A laptop will be provided by the company
- NIGHT SHIFT
- WORK FROM HOME
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