Prior Authorization

Role & responsibilities :

• Review patient information, medical records, and insurance details to determine authorization requirements.
• Verify patient eligibility and insurance benefits.
• Submit prior authorization requests to insurance companies/payers through portals, phone, fax, or other required channels.
• Coordinate with doctors, hospitals, clinical teams, and insurance companies to obtain necessary documentation.
• Follow up on pending authorization requests and ensure approvals are received within required timelines.
• Track authorization status and maintain accurate records in the system.
• Handle authorization denials, identify the reason for denial, and coordinate for resubmission or appeal when required.
• Ensure compliance with insurance guidelines and healthcare regulations.
• Communicate professionally with insurance representatives and internal healthcare teams.
• Meet daily productivity, accuracy, turnaround-time, and quality targets.

Required Skills:

• Good communication skills, especially English.
• Basic knowledge of US healthcare/medical insurance.
• Understanding of Prior Authorization, Eligibility, Benefits, CPT, ICD-10, and medical terminology is an advantage.
• Good computer and documentation skills.
• Attention to detail and ability to work with confidential patient information.
• Ability to work under deadlines and handle multiple cases.
• Basic knowledge of MS Excel and healthcare/RCM software.

For More Details:

Contact : Lakshita - [phone removed]/[phone removed]

Email ID - [email removed]