Prior Authorization and Insurance Eligibility Specialist (Medical and Dental)

Position Summary

Staffingly is hiring a Prior Authorization and Insurance Eligibility Specialist to support a US-based medical and dental billing and collections company. The role sits inside our clients front-end revenue cycle process. You will confirm patient coverage before services are rendered and secure prior authorizations for both medical and dental procedures.

This is a production role with clear daily numbers. Expect 20 to 30 eligibility verifications per day and around 10 prior authorization requests per week. Accuracy matters more than speed. A missed benefit detail or an incomplete authorization request turns into a denial weeks later, so the work has to be right the first time.Role & responsibilities

Preferred candidate profile

Key Responsibilities

Insurance Eligibility and Benefits Verification

- Verify active coverage for scheduled patients through payer portals, clearinghouses, and payer phone lines.
- Confirm plan type, effective and termination dates, deductible, coinsurance, copay, and out-of-pocket status.
- Check dental plan specifics including annual maximums, frequency limitations, waiting periods, missing tooth clauses, and downgrade provisions.
- Identify coordination of perks situations and record primary and secondary payer order.
- Flag terminated or inactive policies to the client contact same day so the front office can reach the patient before the appointment.
- Document every verification in the practice management or billing system with the reference number, representative name, and date of the call.

Prior Authorization

- Determine whether a procedure or service requires prior authorization based on the specific payer and plan.
- Prepare and submit authorization requests with the supporting clinical documentation, CPT and CDT codes, and ICD-10 diagnosis codes.
- Track pending requests daily and follow up with payers on anything sitting past the expected turnaround.




- Handle peer to peer scheduling requests and route them to the clients clinical staff.
- Prepare appeal packets for denied authorizations, including medical necessity documentation and payer policy references.
- Record approvals with the authorization number, approved units or visits, and the valid date range.

Documentation and Reporting

- Maintain a daily log of completed verifications and authorization activity.
- Report aging or stalled authorization cases to the Team Lead before they affect the schedule.
- Escalate payer policy changes, portal outages, or repeat denial patterns to the assigned Customer Success Manager.
- Keep all notes clear enough that another team member can pick up the case without a handoff call.

Required Qualifications

- Two or more years of hands-on experience in insurance eligibility verification, prior authorization, or US medical billing.
- Working knowledge of commercial payers, Medicare, Medicaid, and dental plan structures.
- Familiarity with CPT, CDT, HCPCS, and ICD-10 coding at the level needed to submit clean authorization requests.
- Comfortable calling US payer representatives and holding a productive conversation without a script.
- Clear spoken and written English. Neutral accent preferred for payer calls.
- Experience with payer web portals such as Availity, Navinet, and Dentalxchange, or the ability to learn new portals quickly.
- Clinical training background such as MBBS, BDS, Pharm D, or nursing is strongly preferred and consistent with our delivery model.
- Reliable high-speed internet, a backup connection, and a private workspace suitable for handling protected health information.

Preferred Qualifications

- Prior experience supporting a third-party billing company rather than a single practice, so you are used to handling multiple provider setups.
- Exposure to both medical and dental authorization workflows in the same role.
- Experience writing appeal letters and pulling payer medical policy documents.
- Working knowledge of the CMS interoperability and prior authorization rule, CMS-0057-F, and how payer response timelines are changing under it.

📌 Prior Authorization and Insurance Eligibility Specialist (Medical and (Hyderabad)
🏢 Staffingly
📍 Hyderabad