ph Registered Nurse - prior authorization | cebu (onsite)Omega Healthcare Management Services Inc.

PH REGISTERED NURSE - PRIOR AUTHORIZATION | CEBU (ONSITE)
 
Job Purpose
 
Authorizations Management is a service delivery team that works to obtain prior authorizations and referrals for medical practices throughout the US. We work to take the burden off practices by initiating the authorization process as soon as providers order medical services.
 
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
Required Skills:
Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
Comprehensive understanding of Medical Terminology
Prior experience in processing multispecialty authorizations including contact with payers
Experience in medical coding specially for Cardiac procedures
Experience with general computer software (Internet, Word, Outlook, PDF required)
Proficiency to learn new software programs quickly
Excellent customer service skills: communicates clearly and effectively
Excellent verbal and written communication skills
Professional and effective interaction skills with co-workers, clients, providers, and vendors
Proven ability to work well individually and as a team member
Strong attention to detail
Ability to follow company and account-specific standard operating procedures and policies
Ability to adapt to constantly changing environment
Ability to prioritize and organize multiple tasks by remaining focused and quality-driven at all tasks at hand
Ability to remain organized with multiple interruptions
Ability to make decisions independently without bypassing any company and account-specific standard operating procedures and policies
Ability to comfortably receive constructive feedback
Required Experience:
Graduate of Bachelor of Science in Nursing with active PH Registered Nurse License
1-2 years of experience in business process outsourcing in Authorization