Healthcare Authorization Specialist

Job Overview

We are seeking a detail-oriented Healthcare Authorization Specialist to support the timely coordination of insurance verification and prior authorization processes for patient treatments. This role is responsible for verifying insurance eligibility and coverage, obtaining prior authorizations, maintaining accurate documentation, and coordinating with insurance providers and internal teams to ensure patients receive timely access to care.

The ideal candidate has strong analytical and organizational skills, excellent communication abilities, and a solid understanding of medical terminology. As this role directly supports patients awaiting cancer treatment, the ability to work efficiently and accurately under time-sensitive conditions is essential.

Job Details

• Work set up: Work from Home
• Schedule: Monday to Friday | 9:00 PM to 6:00 AM (Manila Time)
• Holiday: Will follow US holidays

Responsibilities

• Verify patient insurance eligibility, benefits, and coverage prior to treatment or service.
• Secure prior authorizations from insurance companies for scheduled medical services and treatments.
• Complete and submit authorization requests accurately and within required turnaround times.
• Communicate with insurance providers via phone and payer portals to obtain authorization approvals and verify coverage details.
• Coordinate with internal clinical and administrative teams regarding authorization status and any additional documentation requirements.
• Maintain accurate and up-to-date records of insurance verifications, authorizations, approvals, denials, and follow-up activities.
• Monitor pending authorization requests and proactively follow up to prevent delays in patient care.
• Review payer requirements and ensure all submitted documentation meets insurance guidelines.
• Escalate authorization issues or delays to the appropriate internal stakeholders when necessary.
• Ensure compliance with patient confidentiality requirements and applicable healthcare regulations.
• Perform other related duties as assigned.

Qualifications

• Experience in healthcare prior authorization, insurance verification, medical billing, revenue cycle, or a related healthcare administrative role is preferred.
• Strong understanding of insurance eligibility verification, prior authorization processes, and healthcare payer requirements.
• Familiarity with medical terminology.
• Experience navigating insurance payer websites and online portals.
• Excellent verbal and written communication skills, with the ability to interact professionally with insurance representatives and internal teams.
• Strong attention to detail and a high level of accuracy when handling patient and insurance information.
• Strong analytical and problem-solving skills.
• Excellent organizational and time management skills, with the ability to prioritize tasks in a fast-paced environment.
• Ability to work independently while managing multiple authorization requests and meeting strict turnaround times.
• Proficiency in Microsoft Office applications and healthcare information systems or electronic medical records (EMR/EHR) is an advantage.
• Ability to perform effectively in a time-sensitive environment where timely authorizations directly impact patient access to cancer treatment.