Role & responsibilities

- Obtain prior authorizations across all client service lines and document them in the correct location in Athena.

- Work denials end to end. Identify the denial reason, confirm root cause, correct and resubmit where documentation supports it, and appeal where it does not.

- Call payers directly. Do not close a claim as non-recoverable without first contacting the payer, confirming the reason, and asking whether benefits or contract terms changed.

- Pursue retro authorizations where a service was performed without an authorization on file.

- Support letters of medical necessity by gathering the clinical documentation the payer is asking for and coordinating with the onsite team on drafting.

- Identify and report patterns. If the same denial reason repeats, flag it to the client and adjust the authorization process to stop it at the front end.

- Respond to client questions raised in Athena chat within the same business day.

Preferred candidate profile

- athenaOne proficiency. Hands-on athenaOne experience with minimal ramp-up required. This is the client's firmest requirement. Candidates without real Athena time should not be shortlisted.

- Three or more years obtaining commercial and government prior authorizations, including payer portal submissions and phone authorizations.

- Three or more years in denial management or AR follow-up with demonstrated appeal experience on high-dollar claims.

- Working knowledge of CPT, ICD-10, modifiers, and how documentation supports level of service.





- Comfortable calling US payers and holding a line of questioning until the reason is confirmed. Persistence is being explicitly tested for.

- Explicit written English. All client communication happens in writing inside Athena.

- Available for a full shift on Central Time.

- HIPAA trained. Will work only under Staffingly's signed BAA and secured infrastructure.

PREFERRED QUALIFICATIONS

- Prior authorization experience with infusion therapy or specialty drugs, including buy and bill workflows.

- Neurology, physical therapy, or diagnostic imaging authorization background.

- Experience with medical necessity appeals for EEG, NCV, EMG or advanced imaging.

- Clinical background (RN, PharmD, MBBS or equivalent) is a plus for medical necessity work.

DENIAL TYPES THIS ROLE WILL WORK

- No authorization on file or authorization mismatch

- Bundled or inclusive service denials

- Medical necessity denials, most often on CT, EEG and NCV

- Coding denials involving ICD-10 selection or modifiers

- Level of service not supported by submitted documentation

- Frequency limits and benefit maximum reached

PERFORMANCE EXPECTATIONS

- Authorizations obtained before date of service, with the approval documented in Athena in the agreed location.

- No claim written off without a documented payer call and a stated reason.

- Client questions in Athena chat answered same business day.

- Weekly denial trend summary shared with the client, including repeat root causes and the fix applied.

- Quality and productivity reviewed by the assigned Team Lead and by VP, RCM.

📌 Prior Authorization and Denial Management (Hyderabad)
🏢 Staffingly
📍 Hyderabad