Location:
Hyderabad, India (On-Site Only) ? Employment Type: Full-Time ? Work Mode: Strictly On-Site (Remote/Hybrid not available) Role SummaryWe are looking for a dedicated Prior Authorization & Eligibility Specialist to support a US-based sleep medicine practice. The specialist will manage prior authorizations and insurance benefits verification end-to-end, working directly within the practice's EHR and payer portals. As the client is new to outsourcing, accuracy, accountability, and proactive communication will be critical during the initial onboarding period. Schedule
• Full-time, 45 hours per week
• 9-hour shifts (including breaks)
• Aligned with the client's US office hours
• Exact shift timing will be confirmed during onboarding
Key Responsibilities
• Obtain prior authorizations for sleep medicine services, including polysomnograms (sleep studies) and related procedures.
• Complete insurance eligibility and benefits verification alongside each authorization.
• Review medical records and provider notes to ensure documentation supports medical necessity before submission.
• Work authorization requests assigned as tasks in eClinicalWorks (ECW).
• Update task status as work progresses, mark tasks complete, and route follow-up tasks to the appropriate team member.
• Submit and track authorizations through payer portals such as Availity and others used by the practice.
• Set up portal accounts when required.
• Contact payers by phone when portal submissions are unavailable.
• Escalate peer-to-peer review requests immediately to prevent delays or appeals.
• Stay current with payer portal updates and authorization requirements.
• Coordinate with the practice when documentation is missing or incomplete.
• Maintain a live authorization tracker and provide end-of-day reporting.
• Participate in weekly client feedback meetings during the initial engagement period. Expected Volume
• Approximately 30-35 prior authorizations per day
• Eligibility and benefits verification completed alongside authorizations when available through payer portals
• Volume may vary depending on payer response requirements and phone call activity Required Qualifications
• 2-3 years of hands-on prior authorization experience supporting US healthcare practices.
• Hands-on experience with eClinicalWorks (ECW).
• Familiarity with ECW task workflows is strongly preferred.
• Experience using Availity and major commercial and government payer portals.
• Working knowledge of CPT, ICD-10, and medical necessity requirements.
• Experience performing eligibility and benefits verification.
• Healthcare educational background such as PharmD, MHA, Medical Graduate, BPT, Nursing, Life Sciences, or a related healthcare discipline. Preferred Qualifications
• Experience supporting sleep medicine authorizations, including:
• Polysomnograms (Sleep Studies)
• Home Sleep Tests (HST)
• CPAP/DME authorizations
• Experience handling peer-to-peer reviews, scheduling, and appeals. Skills & Traits
• Strong attention to detail and technical accuracy.
• Comfortable working extensively within payer portals and EHR systems.
• Clear and professional written communication.
• Ability to provide timely updates and respond to work-related messages during
working hours
.
• Ability to follow established client workflows and process requirements.
• Strong organizational and follow-up skills. Tools Used
• eClinicalWorks (ECW)
• Availity and other payer portals
• Microsoft Teams
• Staffingly Virtual Desktop Setting Important Note
• This position is strictly in office in Hyderabad. Candidates must be willing to work from the office during US business hours. Remote and hybrid work options are not available for this role.