Prior Authorization Quality AnalystHRTX • Taguig, Metro Manila, Philippines
Prior Authorization Quality Analyst
HRTX • Taguig, Metro Manila, Philippines
30+ days ago
Job descriptionAudit Completing QA audits for their processes by following the QIP Providing feedback to team members on all errors Escalating any anomalies / trends / Compliance issues Performing the actual production work to keep abreast of the latest updates and practical scenarios Participating in client calls to capture process updates and monitoring compliance to the updates Process Contact insurance carriers to verify patients insurance eligibility, benefits, and requirements. Request, track, and obtain pre-authorization from insurance carriers within time allotted for medical and services. Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial. Prioritize the incoming authorizations by level of urgency to the patient. Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate. Respond to clinical questions regarding payer medical policy guidelines
Qualifications
- Must hold an active PHRN license (not a USRN license holder)
- Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review is preferred
- Strong familiarity with EPIC , MCG , or InterQual guidelines required
- Demonstrated job stability , with a consistent employment history and minimal transitions
Job Description
Create a job alert for this search
Quality Analyst • Taguig, Metro Manila, Philippines
Related jobs
Job Overview : We are looking for a highly analytical and results-driven Quality Analyst to support our Outbound Sales Team.
This role is key in driving sales excellence, ensuring s...Show more
QA / Quality Analyst (MOA, Pasay)
TASQ Staffing Solutions • Pasay, National Capital Region, PH
Work Setup : On-site (MOA, Pasay) Shift Schedule : Graveyard Shift Requirements : > .At least 2nd Year College / 72 Units completed > .
QA experience in an Energy / Utilities LOB (Customer Service / Bi...Show more
Last updated: 30+ days ago • Promoted
Quality Analyst
TeleDial Call Center Inc • Pasig, Metro Manila, PH
Quick Apply
Last updated: 30+ days ago
Quality Analyst (BPO)
Swak BPO Corp • Angeles City, Pampanga, Philippines
BPO centers in the Clark Freeport Zone.We pride ourselves on doing great work for our customers with professionalism, energy, and enthusiasm.
Our work environment represents a culture of dedication,...Show more
Last updated: 30+ days ago
Call Center Quality Analyst - Senior Associate (MOA Pasay) - Onsite
TASQ Staffing Solutions • Pasay City, Metro Manila, Philippines
About the job : Quality Compliance Analyst - Senior Associate (MOA Pasay) | Onsite.Year College / 72 Units | Bachelor's Degree (Any Course).
Responsible for coordinating the Internal, External & clie...Show more
Last updated: 26 days ago
Quality Compliance Analyst - Senior Associate (MOA Pasay)
TASQ Staffing Solutions • Pasay City, Metro Manila, Philippines
About the job Quality Compliance Analyst - Senior Associate (MOA Pasay) | Onsite.Year College / 72 Units| Bachelor's Degree (Any Course).
Responsible for coordinating the Internal, External & Client...Show more
Last updated: 30+ days ago
Quality Analyst (AU Telco experience required)
Gear Inc • Muntinlupa City, Metro Manila, Philippines
We are looking for an experienced.This role is responsible for monitoring and improving service quality, ensuring that all customer interactions and delivery workflows meet AU Telco standards.Its a...Show more
Last updated: 30+ days ago
Quality Assurance Analyst I
GRATITUDE JOBS • Pampanga, Pampanga, PH
Qualifications : • Must have a helpdesk-type background (hardware and software troubleshooting experience).Familiar with operating systems troubleshooting.
Knowledge of Microsoft products is required...Show more
Last updated: 30+ days ago • Promoted
Quality Analyst (BPO Healthcare Account)
Quantumgroup Philippines • Taguig, National Capital Region, PH
High school graduate and above; certification in medical billing or healthcare compliance is a plus.US medical billing, with at least 1–2 years in a quality / auditing role.Strong knowledge of CPT, I...Show more
Last updated: 30+ days ago • Promoted
Quality Analyst
Surf Marketing Agency • Makati City Metro Manila, National Capital Region, PH
Qualifications : Quality Analyst – Customer Support (Chat) - Must be amenable to work onsite.Must be currently residing in Makati or within a 15-minute commute to the Makati area.Must be at least a...Show more
Last updated: 30+ days ago • Promoted
Quality Assurance Analyst I (Clark) | Onsite
TASQ Staffing Solutions • Angeles, Pampanga, Philippines
Must have a Helpdesk-type background (hardware and software troubleshooting experience).Familiar with operating systems troubleshooting.
Microsoft product knowledge is required.Should have experienc...Show more
Last updated: 25 days ago
QA Analyst (MOA, Pasay)
TASQ Staffing Solutions, Inc. • Pasay, National Capital Region, PH
Work Setup : On-site (MOA, Pasay) Shift Schedule : Graveyard Shift Requirements : > .At least 2nd Year College / 72 Units completed > .
QA experience in an Energy / Utilities LOB (Customer Service / Bi...Show more
Last updated: 30+ days ago • Promoted
Quality Analyst
RSD Human Resource Management Consultancy • Manila, National Capital Region, PH
Strong knowledge of CPT, ICD-10, HCPCS codes, and payer-specific billing rules.Experience in a call centre environment with exposure to call quality metrics (e.
Excellent analytical, documentation, ...Show more
Last updated: 24 days ago • Promoted
QA Analyst
Vertere Global Solutions Inc • Taguig, National Capital Region, PH
Responsibilities : Plan, develop, collaborate, design and implement test strategies according to QA guidelines Participates in requirements gathering and review the requirements for testability.Pro...Show more
Last updated: 30+ days ago • Promoted
QA Analyst
CPS Asia Pacific • Pasig, Metro Manila, Philippines
The QA Analyst is tasked with creating tests to detect software issues pre-launch, identifying and analyzing bugs, documenting findings, developing and running tests, reporting results, and collabo...Show more
Last updated: 30+ days ago
QA / Test Analyst
Vertere Global Solutions • Taguig, National Capital Region, PH
Responsibilities • Plan, develop, collaborate, design, and implement test strategies according to QA guidelines • Participates in requirements gathering and review the requirements for testabi...Show more
Last updated: 30+ days ago • Promoted
Quality Assurance Analyst
Linaheim Corporate Services Inc. • Pasig, National Capital Region, PH
KEY TASK RESPONSIBILITIES : 1.Conducts compliance checking based on requirements specified by the account or the management team.
Issuance compliance reports and service failures to the account as ...Show more
Last updated: 30+ days ago • Promoted
Quality Analyst - Pasay
TASQ Staffing Solutions • Pasay, National Capital Region, PH
TASQ is looking for three call center quality analysts to work onsite in Pasay.Role Description This is a full-time remote role for a Quality Compliance Analyst.
The Quality Compliance Analyst will...Show more
Last updated: 30+ days ago • Promoted
Quality Assurance Analyst I (Clark, Pampanga)
TASQ Staffing Solutions • Angeles, Pampanga, Philippines
About the job : Quality Assurance Analyst I (Clark) | Onsite.Must have a Helpdesk-type background (hardware and software troubleshooting experience).
Familiar with operating system troubleshooting.Mi...Show more
Last updated: 21 days ago