Prior Authorization Specialist (End to End Prior Authorization)

Responsibilities:

• Coordinate scheduling processes and route all required documentation to meet physician and facility requirements.

• Maintain accurate, thorough, and complete documentation related to patient procedures and treatment plans.

• Respond promptly to scheduling inquiries and return calls in a timely manner.

• Ensure all required medical clearances are obtained prior to scheduled procedures or surgeries.

• Obtain insurance authorizations and approvals before the surgery date.

• Verify insurance coverage and confirm eligibility prior to procedures.

• Collect payments for procedures and outstanding patient balances.

• Reschedule procedure appointments as necessary while maintaining schedule accuracy.

• Support ancillary administrative tasks, including:

  • Following up with patients who cancel or do not attend scheduled surgical appointments.
  • Sending History & Physical (H&P) orders, consents, and other required documentation to outside hospitals and facilities.

• Collaborate effectively with the Patient Services Department and other internal teams to ensure seamless patient care.

• Establish and maintain positive working relationships with physicians, staff, management, and external healthcare facilities.

• Document work processes and maintain records in accordance with organizational standards.

• Demonstrate professionalism, empathy, and exceptional customer service when interacting with patients and their families.

• Perform other related duties as assigned by management.

WORK ONSITE IN EASTWOOD, QUEZON CITY

Qualifications

• Minimum of 6 months of experience in surgery or procedure scheduling.

• End-to-end Prior Authorization experience required, including submitting authorization requests, obtaining approvals, coordinating with insurance carriers, tracking authorization status, resolving denials, securing reconsiderations when applicable, and ensuring approvals are in place prior to procedures.

• Experience with insurance verification, pre-certification, and prior authorization processes.

• Proficient in Microsoft Office Suite, including Word, Excel, and Outlook.

• Strong customer service skills with a professional, courteous, and patient-focused approach.

• Excellent verbal and written communication skills.

• Strong organizational skills with the ability to manage multiple tasks and deadlines.

• Detail-oriented and highly accurate in documentation and scheduling activities.

• Ability to work collaboratively as a team player while maintaining professionalism and respect in all interactions.

• Experience working in a healthcare, surgical, or outpatient setting preferred.