prior authorization specialist | us Healthcare AccountTahche Outsourcing Services Inc.

Our US partner is one of the leading Medical Digital Imaging Service Providers in New Jersey. They offer a full spectrum of diagnostic imaging services in comfortable, convenient, and friendly outpatient imaging centers.
 
As a Prior Authorization Specialist, you are responsible for obtaining pre-certifications and pre-authorizations for procedures and medications, scheduling appointments for outpatient testing with other providers, transcribing and triaging patient calls to physicians, and coordinating patient appointments/orders. 
 
This is a full-time role, on a US shift and on a Work in the office set-up.
If you have the right skill set, this may be your opportunity to enter this fast-growing organization.
 
DUTIES AND RESPONSIBILITIES:
Responsible for day-to-day monitoring of the Radiology Worklist. 
Sorting of cases based on priority. 
Calling out to Insurance Companies for insurance verification, referrals and auth process. 
Case creation in eviCore or another Insurance Portal as required. 
Request additional clinicals as needed. 
Review clinicals received and ensure it meets insurance clinical guidelines for authorization. 
Monitoring of pending cases for approval or denials 
Make necessary follow-ups on insurance, clinics on pending/denied cases. 
Take action on pending cases if it requires additional clinicals, CPT recommendations, and among others. 
Notification to the provider or medical assistant for pending or denied cases. 
Other tasks as given by an immediate superior. 
QUALIFICATIONS:
At least 2nd-year College Level/Senior High School graduate
With at least 1 year and above experience in obtaining Prior Authorization in a healthcare environment. 
Knowledgeable in CPT codes and DX codes
Familiar with different insurance portals and websites
ESSENTIAL SKILLS:
Good verbal and written communication 
Detail Oriented 
Good understanding of the Pre-Certification Process 
WHAT'S IN IT FOR YOU? (Be part of a Dynamic US Team!)
Full-time permanent position
Competitive base salary with allowance
13th-month pay
Paid Leaves and Service Incentive Leaves
Health insurance with dental coverage upon regularization with the opportunity for an additional 2 dependents
We cover Government-mandated benefits (SSS, Phil health, Pag Ibig, Maternity or Paternity leave benefit, Solo Parent Leave, etc.)
Participate in a variety of activities, including team outings, sports events, and other fun events to foster camaraderie.
Follow us on our official social media platforms and be updated with the latest news and hirings!
Facebook: https://www.facebook.com/tahchecareers 
Linkedin: https://www.linkedin.com/company/tahche-careers 
Instagram: https://www.instagram.com/tahchecareers/ 
TikTok : https://www.tiktok.com/tahche.careers 
Youtube: https://www.youtube.com/channel/UC7JTHWeL8Mf2hx5s-LieXAA 
 
Apply now and be part of Tahche!
Not a candidate? If you're a foreign business looking to build world-class teams with top Filipino professionals, why not HIRE WITH TAHCHE? Visit our website at tahche.ph to learn how.