PHRN Medical Billing - Ortigas

WITH SIGNING BONUS!*

Work setup: 100% Onsite (Ortigas, Pasig City)

Shift: Shifting schedule - predominantly Nightshift

Start Date: January 29, 2026

Responsibilities:

Coverage and Access Specialist (PHRN)

• Professionally and compliantly interact with insurance payer representatives during outbound phone calls for benefit verifications (New BVs, Annual reverification BVs and Bridge Eligibility Checks) and coverage exception follow up calls (Prior Authorization (Pas), Non- Formulary Exceptions (NFEs) and Appeals)
• Volume and case type to be worked to be determined by Novartis, but in collaboration with supplier based on current SLAs within the PSC and expected agent productivity
• Accurately and concisely document payer interactions to inform cross-functional partners on the patients coverage status

Care Navigator (PHRN)

• Develop and maintain Subject Matter Expert (SME) level knowledge of the relevant brand and customer workstreams for the specific assigned program
• Learn and utilize protocols to respond to customer phone, chat, fax, SMS / text, mail, and e-mail inquiries as well as other communication channels in a prompt and courteous manner
• Professionally and compliantly interact with customers, relevant Novartis associates, and other external contacts during inbound and outbound phone calls
• Manage assigned cases throughout the patient journey; perform proper and timely escalation, tracking, triage and follow-up where required

Requirements:

• Must have an active PHRN license
• PHRN with BPO experience at least 1 year in prior authorization or 1 year eligibility, claims and benefits (payer)
• Good English communication skills
• Knowledge of healthcare regulations and compliance
• Ability to work independently and as part of a team