Prior Authorization Specialist & Team Lead

Job Title: Prior Authorization Specialist & Team Lead
Department: Revenue Cycle Management (RCM)
Reports To: Prior Authorization Team Lead / RCM Manager

The Prior Authorization Specialist is responsible for obtaining pre-approvals from insurance companies for medical procedures, treatments, diagnostic tests, and medications before services are provided. The primary goal of this role is to ensure timely authorization to prevent claim denials and delays in patient care and reimbursement.

Key Responsibilities

• Submit prior authorization requests to insurance providers for medical services, procedures, and medications.
• Verify patient insurance eligibility and benefits.
• Coordinate with physicians and clinical staff to obtain required medical documentation.
• Follow up with insurance companies via phone, fax, or online portals to track authorization status.
• Maintain accurate records of authorizations, approvals, denials, and pending requests.
• Review denied authorizations and initiate the appeal process when necessary.
• Ensure patient records and authorization details are updated accurately in the system.
• Comply with HIPAA regulations and healthcare compliance standards.
• Communicate authorization requirements and updates with patients and healthcare providers.
• Work closely with the billing and RCM team to ensure smooth claim processing.

Required Skills

• Basic knowledge of medical terminology
• Understanding of insurance authorization processes
• Strong communication and coordination skills
• High attention to detail and organizational skills
• Experience with healthcare software and EMR systems
• Ability to manage multiple tasks and meet deadlines

Required Skills

• Strong leadership and team management abilities
• Advanced knowledge of prior authorization processes
• Excellent communication and problem-solving skills
• Analytical thinking and reporting skills
• Experience with EMR systems and healthcare billing software

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field (preferred)
• 1–3 years of experience in medical billing, prior authorization, or healthcare administration
• Knowledge of Medicare, Medicaid, and commercial insurance policies

Job Type: Full-time

Pay: Rs220,000.00 - Rs320,000.00 per month

Work Location: In person