Prior Authorization & Surgical Scheduling Coordinator

Work Schedule: US Working Hours / Night Shift
Work Location: Cyberscape Alpha, Ortigas Center, Pasig City (Onsite)

What is your mission?

We are looking for a highly organized Prior Authorization & Surgical Scheduling Coordinator to support multiple providers by managing prior authorizations, insurance verification, surgical scheduling, and pre-operative documentation. The role is responsible for coordinating procedure cases, verifying eligibility and benefits, compiling required clinical documentation, maintaining scheduling coverage, and ensuring compliance with HIPAA, Protected Health Information (PHI) protocols, and payer-specific requirements while supporting efficient surgical operations.

You will provide the best service to our partner brands by performing these tasks:

• Manage end-to-end prior authorizations, insurance verification, and pre-operative documentation for assigned providers.
• Submit prior authorization requests for MAC and light anesthesia procedures accurately and within required timelines.
• Verify patient eligibility, coverage, deductibles, coinsurance, and Coordination of Benefits (COB) across commercial insurance plans, Medicare, Medicaid, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Workers' Compensation, and Motor Vehicle Accident (MVA) claims.
• Gather, organize, and submit required clinical documentation and diagnostic imaging to satisfy payer medical necessity requirements.
• Schedule procedure cases in eClinicalWorks (eCW) to maintain adequate anesthesia coverage across assigned providers.
• Coordinate post-operative appointments for designated internal providers and ensure scheduling accuracy.
• Maintain accurate patient, insurance, authorization, and scheduling records within Electronic Medical Record (EMR) systems.
• Follow established escalation procedures for cases requiring clinical review or judgment.
• Maintain strict compliance with HIPAA guidelines, PHI protocols, confidentiality standards, and organizational security procedures.
• Verify patient identity and authorization before releasing or discussing protected information.
• Utilize secure documentation, portal communication, faxing, and information-handling processes to safeguard patient data.
• Report suspected privacy, security, or confidentiality incidents according to organizational policies.

Who are we looking for?

• Bachelor's degree in any healthcare-related, business, or relevant field is an advantage.
• At least 2 years of healthcare administrative experience with a strong background in prior authorization, insurance verification, or surgical scheduling.
• Proven experience handling surgical prior authorization submissions, insurance eligibility verification, Coordination of Benefits (COB), deductibles, and coinsurance reviews.
• Experience supporting multiple providers while managing a high-volume authorization and scheduling pipeline.
• Experience working in healthcare accounts, specialty clinics, pain management, surgical practices, or related healthcare environments.
• Experience with Electronic Medical Record (EMR/EHR) platforms; eClinicalWorks (eCW) experience is highly preferred.
• Working knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases, Tenth Revision (ICD-10) coding related to prior authorization submissions.
• Ability to compile and submit clinical documentation and diagnostic records in accordance with payer requirements.
• Familiarity with MAC and light anesthesia procedure authorizations is preferred.
• Strong knowledge of insurance benefits, payer guidelines, authorization workflows, and healthcare documentation processes.
• Ability to maintain strict confidentiality and properly handle Protected Health Information (PHI).
• Strong attention to detail and accuracy.
• Excellent organizational and time management skills with the ability to meet daily productivity targets.
• Strong problem-solving and follow-through skills when managing authorization requests, appeals, and urgent cases.
• Effective written and verbal communication skills.
• Dependable, punctual, and comfortable working on a permanent night shift schedule.
• Adaptable and capable of managing changing priorities in a fast-paced healthcare environment.

Company Perks:

• Above-industry salary package and incentives
• Comprehensive HMO benefits and life insurance from day 1
• Free learning and development courses for your personal and career growth
• Dynamic company events
• Opportunities for promotion
• Free meals and snacks