AGS Health, LLC (AGS) is a technology-enabled Revenue Cycle Management ("RCM") company that provides financial clearance, financial management, and clinical coding solutions and services to healthcare providers and vendors across the US. AGS Health has 10,200 employees across multiple offices in India and the US. The company generates annualized revenues of over $US 100 million. The CEO and the company have ambitions to transform from a traditional healthcare services company to an integrated technology and services organization that serves an expanded set of customer segments and offers a more diverse set of products and services.

• Excellent Company Culture
• Day 1 Health Insurance, plus free dependent
• Fixed schedule and fixed weekends off
• Non-Toxic | Blended Non-Voice Account
• Employee Referral Incentive
• Opportunity for promotion

1. Audit

• Completing QA audits for their processes by following the QIP
• Providing feedback to team members on all errors
• Escalating any anomalies / trends / Compliance issues
• Performing the actual production work to keep abreast of the latest updates and practical scenarios
• Participating in client calls to capture process updates and monitoring compliance to the updates

2. Process

• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements. 
• Request, track, and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Review, request, follow up and secure authorizations for high dollar cost oncology chemotherapy drugs.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. 
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. 
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial.
• Prioritize the incoming authorizations by level of urgency to the patient.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate. 
• Respond to clinical questions regarding payer medical policy guidelines

• Must hold an active PHRN license (not a USRN license holder)
• Relevant experience as a Quality Auditor in Clinical Services within a healthcare BPO environment; alternatively, 4 to 7 years of specialized experience in Clinical Authorization or Utilization Review is preferred
• Strong familiarity with EPIC, MCG, or InterQual guidelines required
• Demonstrated job stability, with a consistent employment history and minimal transitions

Same as mentioned

• Scanned copy of valid NBI Clearance
• Accomplished Medical or PEME Slip (covered by KMC)
• 2x2 & Half body picture with white background
• Proof of government numbers (TIN, SSS, Pag-ibig, & Philhealth)
• Photocopy of 2 valid IDs – front & back (government-issued)
• Clear copy of your Birth Certificate (PSA or NSO)
• Accomplished HR Forms & Promissory Note (will be provided by KMC’s Onboarding Team

If you're a rockstar at what you do and looking to be a part of our amazing story, we want to hear from you!

We offer attractive salaries and benefits plus you get to work in some of the Philippines' best flexible workspaces. Our employees also get to enjoy exclusive discounts, rewards and freebies, and invites to our monthly events. We are always recruiting for roles in IT & Development, Marketing, Business Administration, HR & Recruitment and Legal & Finance Roles.

KMC provides quality employment opportunities for job-seekers looking for a career that is both challenging and fulfilling. We are also committed to providing equal opportunities at every selection stage. We do not discriminate due to age, gender, sexual orientation, ethnicity, nationality, and religion.

KMC Solutions offers a variety of career opportunities in Metro Manila, Cebu and Clark & Iloilo. We are always looking for talented and enthusiastic individuals who are ready to make their next big career move.

At KMC, we foster an inclusive and positive workplace for all. We push our members to succeed in everything they do through our collaborative work environment. We encourage our community to work hard and reach their full potential while delivering results that matter for our members and you as professionals.

We host amazing and quality events and implement people-centric policies to work flexibly. We ensure that everyone in our expansive network is engaged, from our internal employees and those who work on behalf our offshore partners.

At KMC, we work hard and we are committed to putting our best foot forward in everything we do. Everyone is encouraged to be an individual while also working for the collective good of the KMC Community. We believe mistakes are opportunities and that you should not present a solution without a problem.

We also know when hard work deserves to be recognized so we reward our employees with monthly parties, free trips and much much more!