Prior Authorization Specialist (US Healthcare)

Key Responsibilities:

- Manage end-to-end Prior Authorization processes for both medical services and medication authorizations.
- Verify patient insurance eligibility, benefits, and coverage.
- Submit, monitor, and follow up on prior authorization requests with insurance providers.
- Process and track medication prior authorizations through CoverMyMeds.
- Coordinate with physicians, clinics, and internal teams to obtain required clinical documentation.
- Track authorization status and ensure timely approvals to avoid delays in patient care.
- Maintain accurate records and update authorization details in the practice management/EHR system (eClinicalWorks)
- Ensure compliance with payer guidelines, client requirements, and HIPAA regulations.
- Review authorization denials, prepare appeals or resubmissions, and follow up until resolution.
- Communicate authorization updates to clients and internal stakeholders as needed.

Required Qualifications:

- 1–3+ years of experience in US Healthcare Prior Authorization.
- Strong understanding of insurance verification,



payer guidelines, and authorization workflows.
- Hands-on experience with CoverMyMeds for medication prior authorizations would be an added advantages. Not Mandatory.
- Excellent communication, analytical, and follow-up skills.
- Ability to manage multiple tasks while meeting turnaround time (TAT) requirements.
- Proficiency in Microsoft Office (Excel, Outlook, Word).

Preferred Qualifications:

- Prior experience with eClinicalWorks (eCW) is a strong advantage.
- Experience working with multiple commercial insurance plans and Medicare
- Shift Timings: 5.30 P.M IST to 3 A.M IST (Night Shift Only)
- This job is purely work from office only.
- Share your resume : [email protected]
- Apply through our Career Page: https://lnkd.in/dt74EJpG

For employee benefits & job-related queries, contact HR: +91 95103 36856 | 73598 06462

Pay: ₹25,000.00 - ₹45,000.00 per month

Perks:

- Commuter assistance
- Leave encashment

Work Location: In person

📌 Prior Authorization Specialist (US Healthcare) (Ahmedabad)
🏢 JV Healthcare Solutions
📍 Ahmedabad