onsite licensed Nurse with prior authorization experienceOmega Healthcare Management Services Inc.

ONSITE LICENSED NURSE WITH PRIOR AUTHORIZATION EXPERIENCE (LAHUG CEBU)
 
Required Experience
Candidates must possess a bachelor's degree.
Must be active license holder for PH-RN
Preferably with minimum of 1-year experience in Prior authorization
Job Duties and Responsibilities
Prioritize incoming authorization and referral requests according to queue urgency
Review patient's clinical and chart documentation related to the service submitted by the provider's office
Obtain and/or follow up on authorization and referral requests from the patient's payer/s through any of the following methods-depending on the payer's policy:
Perform outbound calls to payer's authorization department
Access payer's authorization online portal
Submit faxes to payer's authorization department
Respond to payer's clinical questions to be able to proceed with the authorization and referral requests
Obtain and/or follow up payer's peer-to-peer review requirements and send them back to provider's office for the actual initiation
Cater inbound calls from payers and perform necessary actions required for the task
Listen and review voicemail messages from payers then perform necessary actions required for the task