Prior Authorization Specialist

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 benefits, 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-Authorization.

- Strong knowledge of medical terminology.
- Good understanding of US Healthcare insurance processes.
- Experience working with insurance/payer portals and payer guidelines.
- Strong communication and follow-up skills.
- Excellent attention to detail and documentation accuracy.
- Ability to work effectively in a US/night shift environment.
- Experience with EMR/EHR systems is preferred.
- Must be a Graduate.

Preferred Candidate Profile

* Experience handling authorizations for surgeries, procedures, injections, and DME.

- Experience communicating with insurance companies through voice/telephonic channels.
- Robust analytical and problem-solving skills.
- Ability to manage multiple tasks with minimal supervision.
- Good organizational and follow-up skills.
- Prior experience in a US Healthcare / International Voice Process will be an added advantage.

Compensation & Benefits

* Salary: Up to ₹5.5 LPA

- Maximum Hike: Up to 20%, based on current CTC and experience.
- 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

Interview Process

* Mode: Virtual

- Rounds: 2 Rounds

Joining

Candidates with a notice period of Immediate to 30 Days are preferred. Interested candidates with relevant Prior Authorization experience are encouraged to apply.

📌 Prior Authorization Specialist (Hyderabad)
🏢 Sutherland Healthcare Solutions
📍 Hyderabad