QA Associate - Prior Authorization

Role Overview

We are seeking a QA Associate - Prior Authorization to join our team and ensure the quality, accuracy, and compliance of our prior authorization processes. In this role, you will be responsible for reviewing, auditing, and improving prior authorization workflows, with a focus on validating that all prior authorization requests are processed in accordance with industry guidelines and company standards.

You will work closely with healthcare teams, insurance payers, and cross-functional stakeholders to ensure that our prior authorization system runs efficiently, delivers high-quality outcomes, and supports patient care.

Responsibilities
- Quality Auditing:Perform regular audits of prior authorization requests to ensure they meet required medical necessity criteria and insurance guidelines.
- Process Improvement:Identify opportunities to enhance the quality and efficiency of the prior authorization process and collaborate with the team to implement improvements.




- Documentation Review:Ensure that all prior authorization documentation is complete, accurate, and compliant with healthcare regulations (e.g., HIPAA, payer-specific requirements).
- Compliance Monitoring:Monitor the accuracy and compliance of prior authorization requests in line with internal policies and external regulations.
- Collaboration with Teams:Work closely with healthcare providers, insurance payers, and internal teams to resolve any issues, denials, or discrepancies in prior authorization requests.
- Reporting & Tracking:Maintain detailed records of audits, tracking the outcomes of quality assurance checks, and report findings to management.
- Trend Analysis:Identify recurring issues or bottlenecks in the prior authorization process and work with the team to address systemic challenges.
- Continuous Improvement:Support ongoing training for the team to ensure understanding and adherence to quality standards in prior authorization practices.
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📌 QA Associate (Bengaluru)
🏢 Risa Labs
📍 Bengaluru