Healthcare Prior Authorization Coordinator

About the role

The Healthcare Prior Authorization Coordinator provides essential administrative support to the Utilization Management (UM) department. Working onsite in Makati, the role handles the intake, documentation, and tracking of prior authorization and referral requests, ensuring compliance with client policies and regulatory standards.

Key responsibilities

• Receive, review, and process incoming prior authorization and referral requests, verifying completeness and required information.
• Monitor electronic fax queues, retrieve and index faxed documentation, and upload it to the utilization management platform.
• Prioritize requests based on urgency and regulatory turnaround times, routing them to the appropriate licensed clinical reviewer.
• Track case status, coordinate with internal departments, and follow up on pending items.
• Maintain accurate records while handling Protected Health Information (PHI) in compliance with HIPAA.

Required profile

• Non‑clinical professional comfortable working with providers, members, and clinical staff.
• Ability to work graveyard/shifting hours and follow established workflows.
• Attention to detail and strong organizational skills for managing documentation and case queues.
• Understanding of HIPAA and client security requirements.

Required skills

• Experience with utilization management platforms.
• Proficiency in electronic fax and document management systems.
• Ability to verify demographic, provider, and member information.

What we offer

• Onsite work with the possibility of remote work after training.
• Full‑time, graveyard shift schedule.
• Opportunity to develop expertise in healthcare utilization processes.