Prior Authorization Specialist

We are looking for experienced and detail-oriented Prior Authorization Specialists with strong knowledge of medical terminology and healthcare insurance processes.

The selected candidate will be responsible for obtaining prior authorizations and referrals from insurance companies, verifying patient insurance eligibility, coordinating with insurance payers, and ensuring timely approvals for medical procedures, surgeries, injections, and Durable Medical Equipment (DME).

Key Responsibilities

- Initiate and submit prior authorization requests for medical services, diagnostic procedures, medications, surgeries, injections, and DME.
- Obtain prior authorizations and referrals through payer portals and telephonic communication.
- Verify patient insurance coverage, benefits, eligibility, and authorization requirements.
- Review payer guidelines and ensure all required clinical documentation is submitted accurately.
- Track and monitor authorization requests and follow up with insurance providers on pending cases.
- Update authorization statuses, orders, and tasks in the appropriate systems.
- Coordinate with physicians, clinical teams, and insurance representatives to resolve authorization-related issues.
- Maintain accurate documentation and records in compliance with payer and organizational guidelines.
- Ensure timely completion of authorization requests to avoid delays in patient care.
- Manage multiple authorization requests while maintaining accuracy and turnaround-time requirements.





Required Skills & Qualifications

- Minimum 1.6+ years of experience in Prior Authorization / Pre-Authorization.
- Graduate in any discipline.
- Strong knowledge of medical terminology and healthcare insurance processes.
- Hands-on experience with insurance portals and payer guidelines.
- Experience in handling authorizations for procedures, surgeries, injections, and/or DME is preferred.
- Excellent communication, coordination, and follow-up skills.
- Strong attention to detail and documentation accuracy.
- Valuable analytical and problem-solving abilities.
- Ability to work independently and manage multiple tasks with minimal supervision.
- Familiarity with EMR/EHR systems is preferred.
- Ability to work effectively in a fast-paced healthcare environment.

Benefits

- Night Shift Allowance: 100 per working day
- Fixed Week Offs: Saturday & Sunday
- Two-Way Cab Facility: Available within a 25 KM radius
- Self-Transportation Allowance: Up to 3,500 per month
- Excellent career growth opportunities

Job Location: Uppal Shift: Monday to Friday | 6:30 PM to 3:30 AM

Weekly Off: Saturday & Sunday

Employment Type: Full-Time

Preferred: Immediate Joiners to 30 days Notice period

Contact me:- Nikhil-(phone hidden)/ [email protected]

JOB SAFETY NOTICE Sutherland never asks candidates for money or favors in exchange for employment. For suspicious activity, report to [email protected].

📌 Sutherland is Hiring For Prior Authorization (Hyderabad)
🏢 Sutherland
📍 Hyderabad