Prior Authorization & Eligibility Specialist (Sleep Medicine)

? Location: Hyderabad, India (On-Site Only)

? Employment Type: Full-Time

? Work Mode: Strictly In office (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 Environment

Important Note
- This position is strictly on-site 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.

📌 Prior Authorization & Eligibility Specialist (Sleep Medicine) - ON SITE (Hyderabad)
🏢 Staffingly
📍 Hyderabad