Authorization Specialist in Medical Billing

The Authorization Expert is responsible for obtaining, verifying, and managing prior authorizations for medical services to ensure timely reimbursement and compliance with payer requirements. This role works closely with providers, billing teams, insurance companies, and patients to prevent claim denials and delays related to authorization issues.

Key Responsibilities

• Obtain prior authorizations, referrals, and pre-certifications from insurance payers for medical procedures, treatments, and diagnostic services
• Verify patient insurance eligibility, benefits, coverage limits, and authorization requirements
• Review physician orders and clinical documentation to ensure accuracy and compliance with payer guidelines
• Communicate with insurance companies to follow up on authorization status, appeals, and approvals
• Document authorization details accurately in billing and practice management systems
• Identify and resolve authorization-related denials and underpayments
• Collaborate with providers and billing teams to ensure services are rendered within authorization guidelines
• Stay current with payer policies, authorization rules, and regulatory changes
• Maintain compliance with HIPAA and organizational policies
• Meet productivity, accuracy, and turnaround time standards

Required Qualifications

• 2+ years of experience in medical billing, insurance verification, or prior authorizations
• Strong knowledge of insurance plans (commercial, Medicare, Medicaid, managed care)
• Familiarity with CPT, ICD-10, and HCPCS codes
• Experience working with EMR/EHR and medical billing software
• Strong attention to detail and organizational skills
• Excellent verbal and written communication skills

Preferred Qualifications

• Experience in specialty practices (e.g., radiology, surgery, cardiology, orthopedics)
• Certification such as CPC, CPB, or equivalent
• Knowledge of denial management and appeals processes

Skills & Competencies

• Analytical and problem-solving abilities
• Ability to multitask in a fast-paced environment
• Strong follow-up and time-management skills
• Team-oriented with the ability to work independently
• Professional and patient-focused communication style

Job Type: Full-time

Pay: Rs50,000.00 - Rs80,000.00 per month

Application Question(s):

• Will you be able to work in night shift(7pm to 4am)?
• Will you be able to commute to Bahria Town Phase 7 Rawalpindi?

Work Location: In person