Prior Authorization and Eligibility Checker

Vector Outsourcing Solutions Philippines

. Receive requests for prior authorizations using the Scheduling Module of the Electronic Health Record (EHR) and/or via phone or fax and ensure that they are closely monitored .

Posted 10/27/2026contractRemote • PhilippinesMid-LevelSenior💰 ₱30,000 - ₱40,000 per monthWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing prior authorizations and insurance verification processes, ensuring accurate documentation and effective communication with patients and insurance providers. Proficient in utilizing Electronic Health Record (EHR) systems to streamline workflows and enhance patient care.

Highest-signal resume keywords

Prior Authorization ManagementInsurance VerificationElectronic Health Record (EHR) ProficiencyExcellent English Communication SkillsCustomer Centric Approach

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior AuthorizationInsurance Eligibility VerificationMedical Record ProcessingDocumentation AccuracyPatient Benefit Review

Soft Skills

Strong Communication SkillsOrganizational SkillsAbility to Prioritize TasksCustomer Service Orientation

Tools & Technologies

Electronic Health Record (EHR) SystemsOnline Verification Systems

Industry Keywords

HealthcareSenior CareBPO Healthcare AccountConsultancy

About the role

Key responsibilities & impact

Receive requests for prior authorizations using the Scheduling Module of the Electronic Health Record (EHR) and/or via phone or fax and ensure that they are closely monitored
Process referrals and submit medical records to insurance carriers to expedite prior authorization processes
Review the patient's medical history and insurance coverage for approval
Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate
Assist with necessary documentation to expedite approvals and ensure appropriate follow-up
Review the accuracy and completeness of requested information and ensure all supporting documents are present
Follow team and/or client's proper procedures, policies, and methodologies as instructed
Perform other related duties as necessary or assigned
Verify insurance eligibility for new and established patients by contacting insurance companies and using online verification systems
Review insurance plans to ensure proper coverage for Senior/Elder Care, including wellness visits, screenings, and vaccinations
Confirm patient benefits, co-pays, deductibles, and specific requirements or limitations for Senior Care
Provide patients with detailed information regarding coverage, including potential out-of-pocket costs

Requirements

What you’ll need

Graduate of Bachelor's Degree (preferably in Medical, but not required)
Consultancy basis minimum of 6 months consultancy contract (subject for renewal)
At least 1 year of background with Prior Authorization under a BPO healthcare account is an advantage
Must have excellent English communication skills, both written and oral
Ability to prioritize and organize multiple tasks
Strong communication skills and customer centric
Willing to work in shifting schedules, mostly night shift
Able to work from home
Must have a reliable internet connection

Benefits

Comp & perks

Work from home
Equipment/company computer is provided