We are looking for detail-oriented and experienced Prior Authorization Specialist with hands-on experience in specialty pharmacy or RCM environments. The ideal candidate should have strong knowledge of insurance verification, payer guidelines, and authorization workflows.

Key Responsibilities:-

- Obtain and process prior authorizations for specialty and biologic medications in a timely manner.
- Verify patient insurance eligibility, benefits, and coverage requirements.
- Review medical necessity criteria and payer guidelines.
- Prepare and submit complete authorization requests to insurance carriers.
- Follow up with payers to ensure approval within required turnaround times.
- Communicate authorization status with providers, clinical staff, and patients.
- Maintain accurate and compliant documentation in EMR/EHR systems.
- Track authorization requests and maintain work queues.
- Escalate denials and support appeal preparation when needed.
- Stay updated on payer policy changes and specialty drug requirements.





Preferred candidate profile:-

- Minimum 1 year of experience in Prior Authorization (specialty pharmacy, provider, or RCM environment).
- Hands-on experience with prior authorization workflows (not Accounts Receivable).
- Robust understanding of insurance verification and medical necessity review.
- Experience working with Commercial, Medicare, and Medicaid payers.
- Familiarity with EMR/EHR systems.
- Good communication and follow-up skills.
- High attention to detail and accuracy .

Added Advantage:-

- Experience handling high-cost specialty drug authorizations.
- Exposure to biologic, injectable, or infusion therapies.
- Background in dermatology, oncology, rheumatology gastroenterology, neurology, or similar specialties.
- Experience working in specialty pharmacy or specialty clinic settings.
- Knowledge of payer portals such as TriZetto, Availity, etc.

📌 Prior Authorization Specialist (Uttar Pradesh)
🏢 Vcare Call Centers India
📍 Uttar Pradesh