Job Title: Authorization Specialist
Department: Knowledge Process Outsourcing (KPO)
Domain: Healthcare
Location: Bangalore, India
Salary: 45,000 - 60,000 per month
Job Summary:
We are seeking an experienced Authorization Specialist to join our healthcare team in Bangalore. This role requires strong knowledge of medical insurance processes, including CPT and ICD-10 coding, with a primary focus on managing prior authorizations for medical procedures. The ideal candidate will be detail-oriented, have excellent communication skills, and be able to work efficiently under pressure.
Key Responsibilities:
- Review and Verification
- Assess patient medical history and related documentation to determine the necessity for prior authorizations.
- Review insurance coverage for patients and verify eligibility.
- Ensure familiarity with CPT and ICD-10 coding for accurate processing.
- Insurance Coordination
- Confirm insurance benefits and regularly communicate with insurance companies to submit and manage prior authorizations.
- Utilize insurance carrier websites and portals (e.g., Evicore,
Availity, Cohere) for submitting necessary documents efficiently.
- Monitor daily authorization status and follow up on pending authorizations by contacting insurance providers as needed.
- Documentation and Follow-Up
- Submit appeals for denied authorizations and schedule peer-to-peer calls when required.
- Coordinate with insurance providers to extend authorization dates, request additional units, and process urgent or priority authorizations.
- Accurately document authorization details, approvals, and denials in the Electronic Health Record (EHR) system (e.g., ECW).
- Communication and Issue Resolution
- Maintain transparent communication with healthcare providers, insurance companies, and patients regarding the authorization process and status.
- Monitor patient schedules for potential issues and promptly address them with the healthcare office if needed.
- Respond to calls and correspondence