- Workplace
- Onsite
- Type
- Full-time
- Department
- Healthcare
- Source
- RecruiterFlow
Description
PHRN Specialist (Healthcare Account)
Location: Pasig, Philippines
Work Setup: Onsite
Compensation Flexibility: Open to negotiation for highly qualified candidates.
KEY RESPONSIBILITIES
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Coverage & Access
- Conduct outbound calls to payers for benefit verifications, prior authorizations, non-formulary exceptions, appeals, and bridge eligibility checks.
- Contact patients directly when needed to facilitate coverage resolution.
- Accurately document all interactions and update case records in a timely manner.
- Follow job aids, case workflows, and escalation protocols.
- Meet established SLAs, KPIs, productivity, and quality standards.
- Identify and report adverse events in accordance with compliance requirements.
Care Navigation- Manage cases across the patient journey, including insurance navigation and financial assistance support.
- Respond promptly to inquiries across phone, chat, email, SMS, fax, and other channels.
- Conduct conference calls with payers and patients to resolve access barriers.
- Ensure proper triage, follow-up, and case escalation when necessary.
- Collaborate with internal stakeholders and contribute to process improvements.
- Utilize technology and documentation systems efficiently to support case management.
REQUIRED QUALIFICATIONS
- Active Philippine Registered Nurse (PHRN) license.
- Minimum of two (2) year of acute hospital clinical experience.
- Proven experience working in a US Healthcare BPO setting.
- Strong verbal and written communication skills.
- Ability to work efficiently in a fast-paced, high-pressure environment.
- Detail-oriented with strong organizational and documentation skills.
- Demonstrates professionalism, accountability, and adaptability.
- Willing to work onsite in Ortigas.
- Amenable to a fixed night shift schedule.
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ABOUT LENNOR METIER
Lennor Metier is a specialized executive search and professional recruitment firm helping organizations hire leadership, finance, accounting, human resources, sales, marketing, supply chain, operations, and business-critical talent.
EQUAL OPPORTUNITY STATEMENT
Lennor Metier is committed to fostering an inclusive and equitable recruitment process. All qualified applicants will receive consideration based on their qualifications, experience, capabilities, and business requirements.
DATA PRIVACY NOTICE
By submitting your application, you acknowledge that your personal information may be collected, processed, stored, and shared with authorized stakeholders solely for recruitment-related purposes in accordance with applicable data privacy laws and regulations.
Skills
ComplianceNegotiation