Location: Hyderabad – Uppal
Experience: 1.6+ Years
Employment Type: Full-Time
Shift: US Shift / Night Shift
Salary: Up to ₹5.5 LPA
Notice Period: Immediate Joiners to 30 Days
Interview Mode: Virtual
Interview Process: 2 Rounds
Job Summary
We are looking for experienced and detail-oriented Prior Authorization Specialists with hands-on experience in Prior Authorization / Pre-Authorization within the US Healthcare industry.
The ideal candidate should have a strong understanding of medical terminology, healthcare insurance processes, payer guidelines, and insurance portals. The candidate will be responsible for obtaining prior authorizations and referrals, verifying patient eligibility and advantages, coordinating with insurance providers, and ensuring timely approvals for medical procedures and services.
Key Responsibilities
* Obtain prior authorizations and referrals from insurance companies through payer portals and telephonic communication.
* Verify patient insurance eligibility, coverage, and benefits.
* Review and process authorization requests for procedures, surgeries, injections, and Durable Medical Equipment (DME).
* Submit required clinical and supporting documentation to insurance providers for authorization approval.
* Track, monitor, and update authorization statuses, orders, and tasks in the system.
* Follow up with insurance companies on pending and outstanding authorization requests.
* Maintain accurate documentation and ensure compliance with payer guidelines and organizational standards.
* Coordinate with physicians, clinical staff, and insurance representatives to resolve authorization-related issues.
* Ensure authorization requests are completed within required timelines to avoid delays in patient care.
* Maintain accuracy while handling multiple authorization requests in a fast-paced healthcare environment.
Required Skills & Qualifications
* Minimum 1.6+ years of relevant experience in Prior Authorization / Pre-Aut