Nurse Hiring-USRN + Coding License Up to 130k / USRN 65k / PHRN 50k Pasig site
Precertification Coordinator – Job Description
Job Purpose
Qualifications and salary
1.) USRN with a coding license (Up to 130,000 salary)
-Must hold ALL licenses. 1 valid USRN, 1 Valid coding license and 1 valid PHRN license.
-Must have 1 year bedside experience and 3 years of CDI or coding experience
Willing to work onsite in Ortigas.
2.) USRN applicant - Up to 65,000 salary
-Must have an active USRN license
-Must have at least 2 years of bedside experience
-Willing to work onsite in Ortigas.
3.) PHRN Applicant -Up to 50,000 salary
-Must have an active PRC license
-Must have at least 1 year of bedside experience
-Willing to work onsite in Ortigas.
The Precertification Coordinator is responsible for securing and coordinating prior authorizations and referrals on behalf of the provider’s office for cardiac procedures, including Cardiac Catheterization (Cardiac Cath) and Cardiac Electrophysiology (Cardiac EP), covering both inpatient and outpatient services.
Job Duties and Responsibilities
Prioritize incoming authorization and referral requests based on urgency and queue requirements.
Review patients’ clinical records, medical documentation, and supporting information related to the services requested by the provider’s office.
Process, obtain, and follow up on authorization and referral requests with patients’ insurance payers through various channels, depending on payer requirements, including:
Making outbound calls to the payer’s authorization department.
Accessing and utilizing the payer’s online authorization portal.
Submitting required documentation and requests through fax.
Respond to clinical and medical questions from payers to facilitate the processing and completion of authorization and referral requests.
Identify and coordinate payer-required peer-to-peer reviews and communicate the requirements to the provider’s office for appropriate initiation.
