Prior Authorization Specialist

Job Summary:

We are seeking a highly detail-oriented Prior Authorization Specialist with at least 2-3 years of experience in handling prior authorizations, preferably within rehabilitation therapy services. This role is responsible for assessing authorization requirements, obtaining and maintaining timely authorizations, and supporting patients and providers throughout the care journey.

The ideal candidate is trustworthy, detail-oriented, flexible, and hardworking, with the ability to adapt to changing priorities in a fully remote environment. They possess exceptional verbal and written communication skills and genuinely enjoy helping patients and providers navigate healthcare and insurance-related questions. They are organized, resourceful, and comfortable balancing multiple priorities while maintaining accuracy and professionalism. Successful candidates are curious learners who embrace new systems and processes, proactively identify opportunities for improvement, and understand the critical role authorizations play in supporting patient access, revenue cycle performance, and operational excellence.

Job Responsibilities

• Determine authorization requirements, visit limits, and payer-specific rules for PT, OT, and SLP services across Medicare, Medicaid, commercial insurance, workers' compensation, and other payer types
• Proactively identify patients requiring initial authorizations, reauthorizations, or authorization extensions and obtain approvals before services are rendered
• Submit authorization requests through payer portals, fax, phone, and other payer-required channels in a timely manner to prevent disruptions in care and claim denials
• Obtain, review, and submit supporting clinical documentation necessary to secure authorization approvals
• Monitor authorization status, approved visits, expiration dates, and treatment progress to ensure uninterrupted patient care
• Maintain accurate and complete authorization records, including approval details, visit counts, authorization numbers, and expiration dates
• Communicate authorization requirements, status updates, and determinations clearly to patients, providers, and internal teams
• Serve as a primary point of contact for authorization-related questions and concerns from patients and providers
• Coordinate closely with intake, billing, scheduling, credentialing, and clinical teams to ensure seamless patient onboarding, continuity of care, and authorization compliance
• Analyze authorization denials, prepare appeals and reconsideration requests, and follow through to resolution
• Escalate complex authorization, payer, or operational issues and assist with timely resolution
• Identify opportunities for process, workflow, and system improvements while maintaining compliance with payer requirements, HIPAA regulations, and company policies

Qualifications:

• Minimum 2-3 years of experience in prior authorization in healthcare
• Strong knowledge of authorization requirements, medical necessity documentation, visit limitations, and common payer rules
• Familiarity with U.S. insurance payers, including Medicare, Medicaid, BCBS, commercial insurance plans, and workers' compensation programs
• Experience using payer portals, insurance websites, and phone-based payer communication to obtain and manage authorizations
• Experience preparing authorization appeals, reconsiderations, and medical necessity submissions
• Excellent verbal and written communication skills with the ability to explain complex information clearly and professionally
• Strong customer service mindset and ability to build trust with patients, providers, and internal teams
• Exceptional attention to detail and commitment to accurate documentation and follow-through
• Comfortable learning and navigating new technologies, software platforms, and operational workflows
• Strong organizational, problem-solving, and multitasking skills in a fast-paced environment
• Experience with EMR/EHR, practice management, or healthcare software systems preferred
• Ability to work independently, manage competing priorities, and adapt to changing business needs in a remote environment

Preferred Skills:

• Experience supporting Physical Therapy (PT), Occupational Therapy (OT), or Speech-Language Pathology (SLP) practices
• Familiarity with therapy CPT codes, rehabilitation authorization requirements, and payer-specific therapy guidelines

Pay: Php40,000.00 - Php50,000.00 per month

Benefits:

• Work from home

Work Location: Remote