Prior Authorization Coordinator (Project Base)

Core Responsibilities:

- Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 assigned providers
- Submit prior authorization requests for MAC and light anesthesia procedures accurately and promptly
- Verify patient eligibility, coverage, and COB across commercial payers, Medicare, Medicaid, HMOs, PPOs, Workers' Comp, and MVA
- Gather clinical documentation and diagnostic imaging to satisfy medical necessity criteria
- Schedule procedure cases in eCW to maintain adequate anesthesia day coverage across all 4 providers
- Coordinate post-operative appointments only for the internal provider; omit post-op scheduling for the 3 outside providers who handle their own follow-ups
- Maintain compliance with U.S. HIPAA guidelines and PHI protocols

Requirements

Non-Negotiable:

- Familiarity with insurance verification, benefits, and payer processes
- Strong attention to detail and accuracy
- Experience in healthcare accounts and prior authorization submissions, especially for surgical cases
- Experience checking eligibility, coordination of benefits (COB), deductible, and coinsurance

Required:

- Prior healthcare-related administrative experience, ideally in prior authorization or surgical scheduling
- Experience with electronic medical records (EMR/EHR); familiarity with eClinicalWorks (eCW) is a strong advantage
- Ability to compile and submit clinical documentation to satisfy medical necessity criteria
- Working knowledge of CPT/ICD-10 coding as it relates to PA submissions
- Ability to manage multiple provider accounts and a high-volume pipeline while consistently meeting daily quotas
- Dependability and punctuality, particularly for the assigned overnight shift
- Ability to maintain confidentiality and handle protected patient information appropriately

Preferred / Advantage:

- Prior experience with MAC and light anesthesia surgical procedure authorizations
- Prior experience in a pain management or specialty surgical scheduling setting

Core Competencies:

- Attention to detail and accuracy under deadline pressure
- Time management and quota-driven productivity
- Organization across multiple providers, payers, and queue types
- Problem-solving and follow-through on appeals and expedited requests
- Clear written and verbal communication with payers and provider offices
- Adaptability — transitioning from pipeline clearance to ongoing maintenance
- Respect for patient privacy and confidentiality

Benefits

- Free lunch meal, fruits, snacks, and drinks
- Onsite gym with a free professional instructor
- Weekly fitness activity and an annual fitness challenge where you can win up to 70,000 PHP
- Weekly engagement activities with prizes that are up to 3,000 PHP
- Free upskilling academy to improve your performance and skillset
- State-of-the-art facilities from toilets to your workstation
- Amenities such as sleeping quarters, game area, chat room, shower room