Job Title: Prior Authorization & Eligibility Specialist – Gastroenterology

Location: Remote / Hybrid

Job Type: Full-Time

Job Summary

We are seeking a detail-oriented Prior Authorization & Eligibility Specialist with specialized experience in Gastroenterology. In this role, you will manage insurance verification and secure timely pre-authorizations for GI procedures (including screening and diagnostic endoscopies), advanced GI diagnostics, infusion therapies, and specialized gastroenterology medications.

The ideal candidate understands payer criteria for GI medical necessity, preventive vs. diagnostic coding rules, and drug authorization workflows to ensure seamless scheduling and prevent revenue cycle delays.

Key ResponsibilitiesGI Prior Authorization Management

- Initiate, track, and secure prior authorizations for outpatient and ambulatory surgery center (ASC) procedures, including Upper Endoscopy (EGD), Colonoscopy, Capsule Endoscopy, ERCP, and pH Monitoring.
- Gather necessary clinical records—such as pathology reports, prior colonoscopy reports, trial of conservative therapy documentation, and clinical notes—to satisfy payer medical necessity guidelines.
- Submit prior authorizations through phone and payer portals (Availity, CoverMyMeds); Perform timely follow-ups to eliminate patient scheduling delays.

GI Insurance & Benefits Verification
- Verify active coverage, deductibles, co-insurance, and out-of-pocket maximums prior to scheduled GI procedures and clinic appointments.
- Distinguish and verify coverage guidelines for preventive screening colonoscopies versus diagnostic colonoscopies (and the impact of pathology findings on patient financial responsibility).




- Ensure ASC, hospital outpatient department (HOPD), and anesthesia facility coverage are verified in advance.

Clinical Coordination & Denial Management
- Collaborate with GI providers to gather additional documentation for Peer-to-Peer reviews or Appeals when an authorization request is initially denied.
- Communicate authorization statuses, clinical documentation needs, and patient financial estimates to the scheduling and clinical staff.
- Maintain complete authorization notes, reference numbers, and CPT/ICD-10 code approvals within the Practice Management / EHR system.

Qualifications & SkillsRequirements
- Education: Graduate in any discipline
- Experience: 2+ years of dedicated prior authorization experience, with direct experience in Gastroenterology, Ambulatory Surgery Centers, or GI specialty infusion preferred.
- Coding Knowledge: Familiarity with GI-specific CPT codes (e.g., 45378, 45380, 43239), HCPCS J-codes for GI biologics, and ICD-10 diagnostic codes.
- Software: Experience with EHR/PM systems (e.g., gMed/gGastro, Epic, AthenaHealth) and payer portals (Availity, CoverMyMeds, Medicare/Medicaid portals).

Competencies
- Deep understanding of GI medical necessity criteria and commercial/Medicare preventive screening guidelines.
- High attention to detail with strong organizational and deadline-tracking capabilities.
- Transparent communication skills when interacting with clinical teams, insurance representatives, and specialty pharmacies.

Benefits:
- Internet reimbursement
- Paid time off
- Work from home

Experience:
- Prior Auth or VOB: 1 year (Required)

Work Location: Hybrid remote in Chennai, Tamil Nadu

📌 Prior Auth and Eligibility Verification Specialist (Chennai)
🏢 Sirius Tecserv
📍 Chennai