Job Description
Business Unit:
Resolv was formed in 2022, bringing together a suite of industry-leading healthcare revenue cycle leaders with over 30 years of industry expertise, including Ultimate Billing, First Pacific Corporation, Cutting-edge Healthcare Systems, and Innovative Medical Management. Our DNA is rooted in revenue cycle solutions. As we continue to expand, we remain dedicated to partnering with RCM companies that offer diverse solutions and address today's most pressing healthcare reimbursement and revenue cycle operations complexities. Together, we improve financial performance and patient experience, helping to build sustainable healthcare businesses.
Job Summary:
Responsible for managing prior authorizations and referrals, including verifying insurance eligibility, reviewing clinical data, and ensuring timely approvals. Must demonstrate accuracy (95%+), critical thinking, problem-solving, and the ability to multitask in a fast-paced, team-oriented environment while maintaining compliance with client workflows.
Work Mode: Work from office
Shift Timings:
6pm to 3am (Night Shift)
Location: Mumbai (Vikhroli)
Primary Functions:
· Verify patient insurance coverage and eligibility.
· Identify and complete the correct prior authorization form required for each payer.
· Assist in the initiation of new prior authorization/referrals.
· Review clinical data against specified medical criteria for authorization.
· Review incoming orders for completeness to determine if an authorization will be approved.
· Monitor client schedules for upcoming appointments to ensure timely approvals.
· Follow up on pending requests and maintain proper tracking until closure.
· Utilize payer portals to submit and monitor authorizations.
· Coordinate Peer-to-Peer reviews when necessary.
· Communicate with insurance providers daily to obtain and confirm authorizations.
· Ensure compliance with client workflows, payer protocols, and company standards.