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. 

• At least 2nd-year level/Graduate/Postgraduate/ Doctorate degree in Life Sciences 
• With at least 6 months and above experience in obtaining Pre-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.

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Apply now and be part of Tahche!

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