Prior Authorization & Eligibility Supervisors (Start-up Shared Services) c/o JFI

About the role

The responsible for overseeing the daily operations, performance, quality, and workflow of the pre-certification and benefits eligibility function for orthopedic services, including surgical procedures, Physical Medicine & Rehabilitation procedures, and ancillary services.

Key responsibilities

• Supervise the daily operations of the Pre-Certification and Benefits Eligibility team to ensure timely and accurate completion of authorization work queues
• Provide direction, coaching, training, and support to Pre-Certification and Benefits Eligibility Analysts, including onboarding new team members and reinforcing standard work processes
• Monitor team productivity, quality, turnaround times, and documentation accuracy; identify trends and implement process improvements as needed
• Oversee prior authorization and precertification workflows for orthopedic services, including surgical procedures, PM&R services, and ancillary services
• Review and resolve escalated authorization issues, urgent requests, complex payer requirements, denials, and requests for additional clinical information
• Partner with physicians, clinical staff, scheduling, front-end teams, payers, and leadership to prevent delays in care and support appointment readiness
• Ensure authorization details, reference numbers, payer communications, outcomes, and follow-up actions are accurately documented in the electronic health record (EHR) or authorization system
• Maintain current knowledge of payer requirements, medical necessity guidelines, authorization platforms, CPT, ICD-10, and orthopedic terminology
• Conduct periodic audits of authorization quality, documentation, and compliance with organizational policies, payer requirements, and applicable regulatory standards
• Develop, maintain, and reinforce standard operating procedures, team resources, and centralized communication tools for announcements, updates, coverage planning, and workflow guidance

About you

• Bachelor's degree graduate

• At least 3-5 of experience in prior authorization, insurance verification, benefits eligibility, revenue cycle or patient access in a physician office, hospital, or healthcare/BPO Shared Services

• At least 2 years in managing people

• Strong knowledge of insurance authorization processes, payer requirements, medical necessity guidelines, and denial prevention strategies

• Familiarity with CPT, ICD-10, and medical terminology

• Ability to interpret clinical documentation and payer authorization requirements and guide team members in applying requirements consistently

• Proficient with EHR systems, pre-certification platforms, payer portals, work queues, reporting tools, and Microsoft Office applications

• Excellent leadership, communication, organization, analytical, problem-solving, and time-management skills

• Willing to work onsite (Bridgetown, Quezon City) and night shift schedule