PATIENT CARE COORDINATOR II | BPO Healthcare | Hybrid
JOB REQUIREMENTS:
- Completed 4-year college course
- Minimum of 2 years of experience in BPO Healthcare setting
- Strong understanding of medical terminology, pharmaceuticals, and insurance processes.
- Knowledge of insurance policies, formularies, and prior authorization requirements.
- Excellent communication and interpersonal skills for effective interaction with healthcare providers, patients, and insurance representatives.
- Detail-oriented with a focus on accuracy in documentation and data management.
- Problem-solving skills and the ability to navigate complex healthcare systems.
JOB DUTIES AND RESPONSIBILITIES
1. Manages assigned workload to ensure integrity of encoded data in the client system.
2. Maintains acceptable level of performance including but not limited to attendance, productivity, quality, adherence to company protocols, and internal and external customer courtesy to meet service level agreement (SLA).
3. Utilizes all client/company applications to timely communicate information pertaining to client process and following client-established protocols.
4. Engages in a sound conversation with the client or third-party and negotiates to get desired outcome. Communicates effectively through inbound/outbound call to provide needed information to client.
5. Prepares and submits prior authorization requests for non-biologic medications using multiple systems such as CMM (Centralized Medication Management), Manual form submissions, Verbal PA requests, point32health platform, and rxb.promptpa.com portal.
6. Checks PA status online including monitoring and tracking the status of PA requests through online systems to ensure timely processing and resolution.
7. Doing outbound calls to provider's offices, pharmacies, and insurance companies to gather necessary information and facilitate PA approvals.
8. Prepares and submits of appeals for denied PAs and monitor the status of appeal processes
9. Answers inbound calls to address inquiries and provide assistance to callers regarding PA requests and related queries.
10. Overrides the medication approvals by initiating and managing processes to override medication approval denials when necessary.
11. Extends PA submission expertise to include specialty medications beyond non-biologics, ensuring comprehensive coverage of all medication types.
12. Ensures compliance to company rules and regulations, which shall include but not limited to the Employee Code of Discipline, the policies on Quality Management System (QMS), L2 Information Security Management System (ISMS), Environment Health & Safety (EHS), and Environmental Management System (EMS); Data Privacy Act (DPA); and other duties and responsibilities prescribed for all ADEC employees.
13. Ensures compliance of all Non-Conformity Corrective Action Preventive Action Concessions (NCAPACs) and all other audit findings within the prescribed period.
14. Reports security incidents and/or any identified security weaknesses.
15. Performs other tasks that may be assigned from time to time.
Perks of joining us:
- Earn up to Php 30,000.00***
- Primarily work from home but subject to change based on business need.
- HMO DAY1 with FREE one dependent***
- 15% Night Differential (Nightshift)
- Healthy working environment
- Free webinars and internal trainings/events and more!
OFFICE LOCATED AT ALABANG CORPORATE CENTER, MUNTINLUPA CITY
Employer questions
- What's your expected monthly basic salary?
- Which of the following types of qualifications do you have?
- How many years' experience do you have as a Patient Care Coordinator?
- Have you worked in a call centre before?
Company profile
We are ADEC Innovations: Your partner in navigating your sustainability journey.
ADEC Innovations advances sustainable practices around the world and helps organizations grow and operate responsibly. Seamlessly delivering fully integrated, cost-effective consulting, data management, and software solutions, ADEC Innovations helps clients save time, reduce costs, optimize resource use, and drive operational efficiencies in a world where sustainability matters.
We have over 30 years of group experience in data management, software solutions, professional services and workforce solutions. Our products and services cover various industry sectors such as education, health information, environmental services and compliance.
As this website allows us to collect your information through your resumes, please check our Privacy Notice by visiting: https://www.adec-innovations.com/privacy-statement/
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