Go-Get Data Consultancy PHRN – Clinical Authorization

Go-Get Data Consultancy

C$980-1.1K[Monthly]

On-site - Taguig1-3 Yrs ExpBachelorFull-time

Job title: PHRN – Clinical Authorization
Work set up: Onsite Opportunity – MCK Taguig, Cyber Sigma Building
Work schedule:Weekdays Night Shift schedule, Fixed Weekends Off
Salary: 45K to 50K package if licensed PHRN, salary for approval if non-licensed

Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirements.
Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
Prioritize the incoming authorizations by level of urgency to the patient.
Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
Respond to clinical questions regarding payer medical policy guidelines

Active PHRN license preferred but not required, as long as the candidate is a BS Nursing graduate
Must not hold a USRN license
At least 6 months of experience in Clinical or Prior Authorization, with familiarity in medical necessity guidelines or criteria
At least 6 months of bedside nursing experience preferred but not required
Knowledge in EPIC or any Electronic Health Record preferred
Must be amenable to start immediately, onboarding will start on Wednesday, April 30

PHRNMedicalElectronic Health Record