We are looking for detail-oriented and experienced Prior Authorization Specialist with hands-on experience in specialty pharmacy or RCM settings. 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 setting).
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