Insurance & Authorization Analyst

Job Title: Insurance & Authorization Analyst (Revenue Cycle / Patient Access)

Role Overview

The Insurance & Authorization Analyst is responsible for supporting and optimizing insurance coverage verification and prior authorization workflows within healthcare systems. This role ensures accurate benefit validation, rule configuration, and timely prior authorization approvals to reduce denials and improve revenue cycle performance.

The ideal candidate has strong experience in coverage workflows, authorization management, rule configuration, and payer coordination across hospital and ambulatory environments.

Key Responsibilities

Coverage & Authorization Workflows

• Support end-to-end insurance workflows including:
• Eligibility verification
• Benefits validation
• Referral tracking
• Prior authorization submission and follow-up
• Configure and maintain insurance plans, payers, and benefit structures.
• Ensure accurate capture of coverage information during scheduling and registration.
• Monitor authorization status to prevent delays in patient care.

Rule Configuration & System Build

• Configure and maintain:
• Coverage validation rules
• Authorization triggers based on CPT/HCPCS codes
• Medical necessity checks
• Payer-specific documentation requirements
• Build edits and alerts to prevent scheduling without required authorization.
• Support testing and validation of build changes during system upgrades.
• Collaborate with IT teams to implement workflow enhancements.

Prior Authorization Optimization

• Analyze denial trends related to authorization issues.
• Identify bottlenecks in the prior authorization process.
• Develop standardized workflows for high-volume procedures.
• Optimize automation for authorization tracking and reminders.
• Implement best practices to improve approval turnaround time (TAT).

Payer & Stakeholder Collaboration

• Coordinate with insurance companies and third-party administrators.
• Partner with clinical departments to gather medical necessity documentation.
• Work closely with revenue cycle and billing teams to reduce claim denials.
• Train front-desk and scheduling teams on authorization requirements.

Reporting & Analytics

• Develop and maintain reports on:
• Authorization turnaround time
• Denial rates related to coverage issues
• Missing or incomplete authorizations
• Monitor KPIs to improve first-pass claim success rates.
• Provide insights to leadership on revenue impact and process improvements.

Compliance & Risk Management

• Ensure compliance with payer policies and regulatory requirements.
• Maintain documentation for audit readiness.
• Protect patient financial and coverage data integrity.

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Health Informatics, Finance, or related field (or equivalent experience).
• 4+ years of experience in insurance verification and prior authorization workflows.
• Strong understanding of revenue cycle and patient access processes.
• Experience configuring insurance and authorization rules in healthcare systems.
• Knowledge of CPT/HCPCS coding and medical necessity requirements.
• Strong analytical and problem-solving skills.

Preferred Qualifications

• Experience with enterprise EHR systems (e.g., Epic, Cerner, Meditech).
• Experience working with clearinghouses and payer portals.
• Knowledge of denial management processes.
• Experience in multi-specialty or hospital-based environments.

Key Competencies

• Insurance Verification & Coverage Management
• Prior Authorization Workflows
• Rule Configuration & Validation
• Revenue Cycle Optimization
• Denial Reduction Strategies
• Payer Coordination
• Data Analysis & Reporting
• Cross-Functional Collaboration

Job Types: Full-time, Permanent

Pay: ₹239,281.03 - ₹982,224.09 per year

Work Location: Hybrid remote in Noida