Prior Authorization Coordinator (Project Base)

Core Responsibilities:

• Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 assigned providers
• Submit prior authorization requests for MAC and light anesthesia procedures accurately and promptly
• Verify patient eligibility, coverage, and COB across commercial payers, Medicare, Medicaid, HMOs, PPOs, Workers' Comp, and MVA
• Gather clinical documentation and diagnostic imaging to satisfy medical necessity criteria
• Schedule procedure cases in eCW to maintain adequate anesthesia day coverage across all 4 providers
• Coordinate post-operative appointments only for the internal provider; omit post-op scheduling for the 3 outside providers who handle their own follow-ups
• Maintain compliance with U.S. HIPAA guidelines and PHI protocols

Requirements

Non-Negotiable:

• Familiarity with insurance verification, benefits, and payer processes
• Strong attention to detail and accuracy
• Experience in healthcare accounts and prior authorization submissions, especially for surgical cases
• Experience checking eligibility, coordination of benefits (COB), deductible, and coinsurance

Required:

• Prior healthcare-related administrative experience, ideally in prior authorization or surgical scheduling
• Experience with electronic medical records (EMR/EHR); familiarity with eClinicalWorks (eCW) is a strong advantage
• Ability to compile and submit clinical documentation to satisfy medical necessity criteria
• Working knowledge of CPT/ICD-10 coding as it relates to PA submissions
• Ability to manage multiple provider accounts and a high-volume pipeline while consistently meeting daily quotas
• Dependability and punctuality, particularly for the assigned overnight shift
• Ability to maintain confidentiality and handle protected patient information appropriately

Preferred / Advantage:

• Prior experience with MAC and light anesthesia surgical procedure authorizations
• Prior experience in a pain management or specialty surgical scheduling setting

Core Competencies:

• Attention to detail and accuracy under deadline pressure
• Time management and quota-driven productivity
• Organization across multiple providers, payers, and queue types
• Problem-solving and follow-through on appeals and expedited requests
• Clear written and verbal communication with payers and provider offices
• Adaptability — transitioning from pipeline clearance to ongoing maintenance
• Respect for patient privacy and confidentiality

Benefits

• Free lunch meal, fruits, snacks, and drinks
• 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