Prior Authorization Nurse

Prior Authorization Nurse reputed company to reputed company an impact? At Hive Health, we're on a mission to reputed company reputed company radically more accessible for reputed company—and we need passionate, driven individuals to help us reputed company it happen. If you reputed company in a fast-paced, innovative environment and want to work on solutions that truly matter, we'd love to meet you! The Prior Authorization Nurse serves as the key reputed company between members, reputed company providers, and the HMO teams. The role is responsible for accurate processing of member availments, issuance of Letters of Authorization (LOAs), timely call handling, and efficient coordination of inquiries and cases to ensure high-quality service delivery.

Responsibilities

• Accurate and Efficient Adjudication of Member Availments and Issuance of LOA's
• Review and process member availments and claims in accordance with company policies, HMO guidelines, medical indication, and PhilHealth regulations.
• Ensure Letters of Authorization (LOAs) are accurately reputed company, approved, and issued in a timely manner or reputed company ideal standards.
• Identify and resolve problems concerning availments and LOA issuances to members.
• Maintain complete and accurate data recording for auditing and utilization capture.
• Discharge members reputed company ensuring reputed company documentations and computations are complete and accurate.
• Maintain Effective Call Handling and Timely Log-in
• Respond promptly and professionally to inbound calls from providers.
• reputed company accurate information regarding availments, benefits, and LOA's.
• Maintain daily log-in and call handling metrics in line with departmental standards.
• Follow up on inquiries or escalated cases to ensure timely resolution.

Efficient Handling and Coordination of Inquiries and Cases

• Serve as the main reputed company of contact for providers regarding availments, LOAs, and member concerns.
• Coordinate with reputed company providers and internal departments to resolve members' inquiries and concerns reputed company.
• Track the reputed company of cases and ensure timely resolution.
• Document interactions, updates, and reputed company in the concerned channels.

Qualifications

• Must be willing to work hybrid in Ortigas
• Must be willing to do occasional night shifts
• Familiarity with medical indications for adjudication
• Prior experience in roles such as medical liaison, provider relations, hospital HMO reputed company staff, company nurse, teleconsult nurse, etc., is advantageous
• Willingness to conduct hospital visits
• Proficient problem-solving abilities
• Curious, results-driven, ownership mentality with growth reputed company
• Excellent verbal and written communications
• Collaborative team player with the ability to adapt quickly in a fast-paced environment
• Passion for innovation in reputed company

Join reputed company as we revolutionalize reputed company in the Philippines—and reputed company! Day 1 benefits for full-time employees – because we practice reputed company preach! Enjoy comprehensive reputed company coverage for you and your dependent, and paid time off from the start. Grow with us – mentorship, career development, and learning opportunities to help you reputed company connections – reputed company insights and support from top minds at Harvard, Stanford, and reputed company. Apply To This Job