- Proven ability to communicate effectively with insurance payers, including making outbound calls to verify benefits, obtain authorization requirements, and follow up on authorization requests.
- Experience creating and managing user accounts across payer portals and submitting authorization requests through various payer systems.
- Self-motivated and resourceful professional with strong problem-solving skills and the ability to independently navigate payer processes, resolve authorization barriers, and track request status.
- Demonstrated experience submitting prior authorization requests with all required clinical and supporting documentation to ensure timely and successful processing. This is a mandatory requirement.
- Strong understanding of authorization workflows, payer guidelines,
and documentation requirements within a healthcare revenue cycle environment.
- Experience managing authorizations for out-of-network services is highly preferred and considered a robust asset.
Preferred candidate profile
- 1-4 years of experience in Prior Authorization.
- Experience handling Out-of-Network (OON) authorizations is highly preferred.
- Experience in Eligibility Verification and Benefits Verification is required.
- Knowledge of Accounts Receivable (AR) is required.
- Excellent communication skills.
- Graduation is mandatory.
- Willingness to work in the night shift.