Prior Authorization Coordinator

What is your mission?

We are looking for a detail-oriented Prior Authorization Coordinator to manage insurance authorisation requests, verify patient benefits, coordinate procedure approvals, and support healthcare revenue cycle operations. This role is responsible for prior authorisations, insurance verification, medical documentation review, appeals management, procedure scheduling, benefits verification, and ensuring compliance with U.S. healthcare regulations and HIPAA requirements.

You will provide the best service to our partner brands by performing these tasks:

• Submit and manage prior authorisation requests for medical procedures and secure approvals from insurance providers
• Verify patient insurance coverage, eligibility, and Coordination of Benefits (COB) information to ensure submissions are routed to the appropriate payer
• Review insurance policies and medical necessity requirements to ensure accurate submission of CPT codes, procedure levels, and laterality information
• Compile, review, and submit required clinical documentation, including therapy records, imaging reports, and supporting medical records
• Maintain accurate documentation of authorisations, benefits verification, eligibility reviews, and No Authorisation Required (NAR) notifications within patient records
• Identify patient financial responsibility, including copayments, coinsurance, deductibles, and benefit limitations
• Update and maintain authorisation tracking systems, CRM platforms, and procedure status records
• Coordinate and schedule approved medical procedures
• Communicate with providers regarding order discrepancies, missing documentation, and authorisation requirements
• Review patient medical histories and records to identify factors that may affect procedure approvals
• Analyse denial letters and prepare appeals to overturn adverse insurance decisions when appropriate
• Collaborate with billing, clinical, and operational teams regarding authorisation and claims-related requests
• Ensure compliance with HIPAA, patient privacy regulations, and protected health information (PHI) requirements
• Maintain accurate records and support operational reporting related to authorisation activities

Who are we looking for?

• Bachelor's degree in Healthcare Administration, Nursing, Medical Technology, Business Administration, or a related field preferred
• Experience in prior authorisations, insurance verification, healthcare administration, medical billing, revenue cycle management, or related healthcare support functions
• Experience working with U.S. insurance plans, including Medicare, Medicaid, HMO, PPO, Workers' Compensation, and Motor Vehicle Accident (MVA) claims
• Strong knowledge of healthcare reimbursement processes, payer guidelines, and medical necessity requirements
• Understanding of medical terminology, anatomy and physiology, ICD-10, CPT, and HCPCS coding
• Experience maintaining authorisation records, benefits verification documentation, and healthcare tracking systems
• Familiarity with CRM systems, insurance portals, electronic medical records, and healthcare applications
• Knowledge of HIPAA, patient privacy regulations, and PHI security requirements
• Strong written and verbal English communication skills with the ability to interact effectively with providers, insurance representatives, patients, and internal teams
• Excellent organisational, documentation, and time-management abilities
• High attention to detail with a commitment to accuracy, compliance, and quality
• Strong analytical, problem-solving, and decision-making skills
• Ability to work independently with minimal supervision while managing multiple authorisation requests simultaneously
• Reliable, dependable, and capable of working in a fast-paced healthcare environment

Why you'll love it here?

• Free lunch meals, fruits, snacks, and beverages for employees assigned to onsite shifts.
• Access to an onsite gym with a complimentary professional fitness instructor.
• Weekly fitness activities and an annual fitness challenge with prizes of up to ₱70,000.
• Weekly employee engagement activities with prizes of up to ₱3,000.
• Free upskilling academy to support career growth and professional development.
• State-of-the-art office facilities and modern workstations.
• Access to employee amenities including sleeping quarters, game area, chat room, and shower rooms.
• Fun, collaborative, and employee-focused work environment.