Authorization Specialist Home-based

Job Description

About Us:

Outsourced. ph is a leading ISO-certified Philippines offshore outsourcing company that provides dedicated remote staff to some of the worlds leading international companies. Outsourced is recognized as one of the Best Places to Work and has achieved Great Place to Work Certification. We are committed to providing a positive and supportive work environment where all staff can thrive. As an Outsourced staff member, you will enjoy a fun and friendly working environment, competitive salaries, opportunities for growth and development, work-life balance, and the chance to share your passion with a team of over 1,000 talented professionals

Duties And Responsibilities

Insurance verification

• Verify insurance eligibility and benefits for in-office surgeries and patch allergy testing.
• Check deductible, coinsurance, copay, out-of-pocket max, and benefit limitations
• Identify whether service requires a referral, prior auth, or pre-certification
  
  

Prior Authorization

• Collect and submit required clinical documentation; Submit authorization requests to commercial, state, and federal insurance carriers for medical services. Submit through payer portal, phone, fax, or electronic systems based on payer requirements.
• Ensure complete follow-through on all authorization requests prior to scheduled surgery dates.
• Collaborate closely with the Surgery Coordination team through written channels to ensure timely authorization so that surgeries can proceed as scheduled.
• Maintain an internal tracker from submission to approval/denial to ensure all authorizations in place. Proactively resolve outstanding or delayed requests.
  
  

Surgery Estimates and Patient Financial Responsibility

• Calculate and generate accurate surgery estimates, including deductibles, co-insurance, and patient responsibility.
• Deliver clear surgery estimates to patients via written communication (secure email or portal messages), ensuring clarity, professionalism, and accuracy.
• Maintain detailed and accurate documentation within the patient accounts to support authorization and estimate calculations.
• Flag high-risk financial cases (out-of-network, no benefits, exclusions, etc.)
  
  

Other

• Assist with accounts receivable or additional medical billing tasks as assigned, when capacity allows.
• Follow established billing workflows while identifying opportunities to improve efficiency and accuracy.
• Maintain compliance with payer rules, HIPAA, data security, and internal policies.
• Adhere to established workflows, turnaround times, and quality standards.
• Contribute to a culture of accountability, responsiveness, and continuous improvement.
  
  

Requirements

• College degree preferred but not required
• 2+ years of U.S. healthcare billing experience (medical office, billing company, or RCM support)
• Experience with insurance eligibility verification and prior authorizations is strongly preferred
• Experience working with U.S. commercial insurance plants and Medicare Advantage plans
• Strong knowledge of medical coding, prior authorization workflow, medical necessity documentation
• Familiarity with payer portals is a plus (Availity, UHC, Aetna, etc.)
• Ability to solve problems and troubleshoot issues, high attention to detail
• Strong written and verbal English communication skills to communicate with internal team members and external payors. Must be able to interpret and manage approval letters, denials, and requests for additional information
• Comfortable using multiple browser tabs and portals, pdf tools, Excel
• Track record of maintaining accuracy and organization, even with high volume
  
  

Work Location

• Home-based
• Should have strong internet connection (minimum of 20 mbps)
• Should have own Laptop/PC (minimum of i5 8GB RAM)
  
  

Note: As part of our recruitment process, we conduct a background check on all hired candidates. Please ensure that all required documents are prepared and submitted promptly.

By clicking on the "Im Interested" button I hereby allow Outsourced Quality Assured Services, Inc. ("Outsourced") to store and collect my personal information for the purposes of employment application. As such, I agree and authorize Outsourced to collect, store, or continue to use my personal information for the above-stated purpose, and to retain my personal information for a period of 1 year, and for these purposes only.

---