Authorization Specialist - Managed Care
New
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LimitlessliHealthcare
Manila, PH / Cebu, PH / Davao, PH, US Hours EST - 9am to 6pmFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 3–4 years
- Required Skills
- Microsoft OfficeEHR
Requirements
- Minimum 3–4 years of experience in healthcare insurance authorization, utilization review, managed care, admissions, or related healthcare revenue cycle functions.
- Experience working with Skilled Nursing Facilities (SNFs), rehabilitation services, long-term care, or post-acute care settings preferred.
- Knowledge of Managed Care, Medicare Advantage, Medicaid Managed Care, and commercial insurance authorization processes.
- Strong understanding of medical terminology and clinical documentation requirements.
- Excellent organizational skills with the ability to manage multiple authorizations and deadlines simultaneously.
- Strong verbal and written communication skills.
- Proficiency with electronic health records (EHRs), payer portals, and Microsoft Office applications.
- Ability to work independently while collaborating effectively with interdisciplinary teams.
- Reliable computer and noise-canceling headset.
- Second monitor for enhanced productivity.
- Stable internet connection with a backup internet connection.
Responsibilities
- Obtain initial and continued stay authorizations from Managed Care Organizations (MCOs), Medicare Advantage plans, and other third-party payers.
- Monitor authorization status, track expiration dates, and submit timely extension requests to prevent coverage gaps.
- Collaborate with nursing, therapy, admissions, and case management teams to gather clinical documentation required for authorization requests.
- Maintain accurate authorization records and supporting documentation within the facility's systems.
- Communicate with insurance companies regarding authorization determinations, requests for additional information, and coverage updates.
- Review payer requirements and ensure compliance with authorization guidelines and policies.
- Escalate authorization denials and coordinate with appropriate teams to support reconsiderations or appeals.
- Assist in identifying authorization-related trends, issues, and opportunities for process improvement.
- Support revenue cycle objectives by helping ensure services are authorized and reimbursable.
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