Prior Authorization Specialist – Healthcare CSR | Pasay City

Job Summary

The Prior Authorization Specialist is responsible for securing timely prior authorizations from insurance providers to ensure patient services are approved and compliant with payer requirements. This role involves close coordination with healthcare providers, payers, and internal teams to minimize denials and support efficient revenue cycle operations in a healthcare BPO environment.

• Review and process prior authorization requests for medical procedures, diagnostic tests, and medications
• Verify patient eligibility, benefits, and coverage requirements
• Submit prior authorization requests via payer portals, phone, fax, or electronic systems
• Communicate with insurance companies to obtain approvals, denials, or additional information
• Follow up on pending authorizations and resolve issues in a timely manner
• Document authorization status accurately in EMR, billing, or authorization systems
• Collaborate with providers, clinical staff, and billing teams to ensure compliance with payer guidelines
• Identify and escalate complex cases or potential denials
• Maintain up-to-date knowledge of payer policies, CPT/HCPCS codes, and authorization requirements
• Ensure compliance with HIPAA and company policies

• At least 1–2 years of experience in prior authorization or healthcare revenue cycle management
• Strong knowledge of medical terminology, insurance plans, and authorization workflows
• Experience working in a Healthcare BPO or shared services environment is a plus
• Familiarity with EMR/EHR systems and payer portals
• Excellent communication and documentation skills
• Strong attention to detail and time-management skills
• Ability to work in a fast-paced, metrics-driven environment

• Experience with US healthcare payers (e.g., commercial, Medicare, Medicaid)
• Knowledge of CPT, ICD-10, and HCPCS coding basics
• Denial management and appeals experience
• Strong problem-solving and analytical skills

• Competitive salary and performance-based incentives
• HMO and life insurance coverage
• Paid training and career growth opportunities
• Supportive and collaborative work environment