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accounts receivable & payable specialist

prior authorization specialist

Ali Enterprise

We are seeking an experienced Prior Authorization Specialist to manage and process insurance prior authorization requests efficiently. The ideal candidate must have strong knowledge of U.S. healthcare insurance guidelines and ensure timely approvals to avoid treatment delays and claim denials.Key Responsibilities<ul><li>Process prior authorization requests for medical procedures, treatments, medications, and diagnostic services</li><li>Verify patient insurance eligibility and benefits</li><li>Communicate with insurance companies (Medicare, Medicaid, Commercial Plans)</li><li>Submit clinical documentation to insurance payers as required</li><li>Follow up on pending authorizations and resolve denials</li><li>Coordinate with physicians, medical staff, and billing teams</li><li>Maintain accurate authorization records in EMR/EHR systems</li><li>Ensure compliance with HIPAA and insurance regulations</li><li>Meet turnaround time (TAT) and productivity targets</li></ul>Required Experience &amp; Qualifications<ul><li>Minimum 1&ndash;2 years of Prior Authorization experience (mandatory)</li><li>Strong understanding of US Healthcare &amp; Insurance Policies</li><li>Familiarity with CPT, ICD-10, and HCPCS codes</li><li>Experience with EMR/EHR systems</li><li>Excellent verbal and written English communication skills</li><li>Ability to work under pressure and meet deadlines</li></ul>Skills &amp; Competencies<ul><li>Insurance verification &amp; authorization handling</li><li>Denial management &amp; follow-ups</li><li>Attention to detail</li><li>Multitasking &amp; time management</li><li>Professional communication with payers and providers</li></ul>Job Type<ul><li>Full-time</li><li>Johar Town Lahore</li></ul>Job Type: Full-timePay: Rs180,000.00 - Rs220,000.00 per monthWork Location: In person

Prior Authorization Specialist

Job Title: Prior Authorization Specialist &amp; Team Lead Department: Revenue Cycle Management (RCM) Reports To: Prior Authorization Team Lead / RCM ManagerThe 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<ul><li>Submit prior authorization requests to insurance providers for medical services, procedures, and medications.</li><li>Verify patient insurance eligibility and benefits.</li><li>Coordinate with physicians and clinical staff to obtain required medical documentation.</li><li>Follow up with insurance companies via phone, fax, or online portals to track authorization status.</li><li>Maintain accurate records of authorizations, approvals, denials, and pending requests.</li><li>Review denied authorizations and initiate the appeal process when necessary.</li><li>Ensure patient records and authorization details are updated accurately in the system.</li><li>Comply with HIPAA regulations and healthcare compliance standards.</li><li>Communicate authorization requirements and updates with patients and healthcare providers.</li><li>Work closely with the billing and RCM team to ensure smooth claim processing.</li></ul>Required Skills<ul><li>Basic knowledge of medical terminology</li><li>Understanding of insurance authorization processes</li><li>Strong communication and coordination skills</li><li>High attention to detail and organizational skills</li><li>Experience with healthcare software and EMR systems</li><li>Ability to manage multiple tasks and meet deadlines</li></ul>Required Skills<ul><li>Strong leadership and team management abilities</li><li>Advanced knowledge of prior authorization processes</li><li>Excellent communication and problem-solving skills</li><li>Analytical thinking and reporting skills</li><li>Experience with EMR systems and healthcare billing software</li></ul>Qualifications<ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Business Administration, or a related field (preferred)</li><li>1&ndash;3 years of experience in medical billing, prior authorization, or healthcare administration</li><li>Knowledge of Medicare, Medicaid, and commercial insurance policies</li></ul>Job Type: Full-timePay: Rs220,000.00 - Rs320,000.00 per monthWork Location: In person

Prior Authorization Specialist & Team Lead

Prima Systems

POSITION SUMMARY: The RCC Authorization Coordinator's primary responsibility is to perform stationary, telephonic communication for authorization of rehab services for managed care and insurance customers, with the goal to capture reimbursable managed care and commercial insurance revenue associated with outpatient services, in a timely and accurate manner to maximize timely billing. This position involves a variety of assignments requiring confidentiality and familiarity with the operating details of the overall company.RESPONSIBILITIES/ACCOUNTABILITIES: Authorization: 1. Provide professional support to Rehab Services Operations personnel by obtaining all authorizations on all outpatient managed care and commercial insurance customers in accordance with HIPAA regulations in handling patient confidential information.2. Understand each managed care and commercial insurance plan&rsquo;s authorization/referral process and medical necessity requirements. Update quarterly or as necessary.3. Maintain an ongoing tracking log of all referrals&rsquo; open authorizations/re‐authorizations by facility by plan.4. Navigate insurance plan portals to understand benefit data and patient specific information (primary care physician, etc.) and generate referrals and authorizations if necessary.5. Communicate regularly and consistently concerning any patient or plan updates, via e‐mail and telephone, to rehabilitation and/or facility representatives.6. Maintain and verifies accuracy of records of correspondence, reports, and related matters.7. Assist in compiling and distributing activity reports to supervisor.a. Utilize proprietary software systems, e.g. ROX, etc., in order to accomplish all day‐to‐day tasks, and create the related electronic documentation in order to ensure access toinformation for all concerned.8. Educate new rehabilitation and facility staff as necessary concerning the authorization process and the role of the RCC Authorization Coordinator.9. Work with Managed Care Billing and Rehab Service personnel on billing/collection issues as required to accomplish payment for outpatient services authorized and rendered.Administrative Support: a. Answer and screen phone calls and/or emails.b. Type reports, memos, letters, etc. which often involves matters of a confidential andtechnical nature.c. Prepare and maintain files of correspondence reports and related matters.d. Assist in compiling and distributing all standardized departmental reports.3. Performs other related duties as required.SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. High school diploma or related experience is required for this position.2. Familiarity with insurance terminology is preferred.JOB SKILLS: 1. Strong organizational skills and excellent verbal and written skills.2. Ability to successfully multi‐task under pressure and in stressful situations while maintaining professionalism at all times intact and poise.3. Demonstrates good judgment and initiative in selecting the most effective work methods and tools and be able to prioritize your work.4. Must have the ability to exercise administrative judgment within general guidelines.5. Must possess the ability to positively interact with employees at all levels of the organization and the general public.6. Demonstrates intermediate skills with Microsoft Office, especially with Outlook, Excel and Power Point. Comfortable learning and using proprietary business software applications.7. Must have the ability to accomplish rapid computer data entry.8. Superior internal and external customer service skills.PERFORMS RELATED DUTIES: 1. The RCC Authorization Coordinator interacts with Corporate, Area and center‐based staff on a variety of professional levels.2. S/he carries out other tasks as requested in situations where additional support may be requiredJob Type: Full-timePay: Rs80,000.00 - Rs90,000.00 per monthExperience:<ul><li>authorization: 2 years (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Location:<ul><li>Lahore (Preferred)</li></ul>Work Location: In person

Physicians Revenue Group

Job Type: Full-Time | Onsite Shift Timing: Night Shift (06:00 PM &ndash; 03:00 AM) Weekly Off: Saturday &amp; Sunday Location: LahoreJob OverviewWe are seeking an experienced Authorization Specialist to join our US healthcare operations team. The ideal candidate will have hands-on experience in prior authorization processes within the US healthcare system and a strong understanding of Revenue Cycle Management (RCM). This role requires excellent communication skills, attention to detail, and the ability to independently manage authorization workflows.Key Responsibilities<ul><li>Handle end-to-end prior authorization processes for medical procedures, medications, and services</li><li>Verify patient insurance eligibility, coverage, and benefits</li><li>Submit authorization requests via insurance portals, fax, and outbound calls</li><li>Follow up with insurance companies to ensure timely approvals</li><li>Review and interpret payer guidelines for authorization requirements</li><li>Maintain accurate documentation and authorization records in the system</li><li>Coordinate with billing, coding, and clinical teams to resolve authorization-related issues</li><li>Manage denials related to authorization and initiate re-submissions or appeals when required</li><li>Track and report authorization status using MS Excel or internal systems</li><li>Communicate professionally with insurance representatives and internal stakeholders</li></ul>Eligibility &amp; Requirements<ul><li>Qualification: Bachelor&rsquo;s degree (required)</li><li>Experience: Minimum 1&ndash;3 years of experience in prior authorization / RCM (US Healthcare)</li><li>Strong command of English (spoken &amp; written)</li><li>Hands-on experience with insurance portals and authorization workflows</li><li>Proficiency in MS Excel (tracking, reporting, basic formulas)</li><li>Experience in handling calls with insurance companies</li><li>Must be a permanent resident of Lahore</li><li>Willingness to work night shift (US shift)</li></ul>Skills Required<ul><li>Strong communication and interpersonal skills</li><li>In-depth understanding of prior authorization processes</li><li>Analytical and problem-solving skills</li><li>High attention to detail and accuracy</li><li>Ability to manage workload independently and meet deadlines</li><li>Team-oriented with a professional attitude</li></ul>Why Join Us<ul><li>Fixed night shift with weekends off</li><li>Competitive salary based on experience</li><li>Growth opportunities in US healthcare and RCM</li><li>Structured processes and supportive work environment</li><li>Long-term career progression in medical billing</li></ul>Job Type: Full-timeAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Preferred)</li></ul>Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>Authorization Specialist: 2 years (Preferred)</li></ul>Work Location: In person

Authorization Specialist

Jawa Health Care

Job SummaryThe Prior Authorization Executive is responsible for obtaining pre-approvals from insurance companies for medical procedures, treatments, and medications. This role ensures timely authorization to avoid delays in patient care and reimbursement while maintaining compliance with payer guidelines.Key Responsibilities<ul><li>Initiate and process prior authorization requests via portals, phone calls, or fax</li><li>Verify patient insurance eligibility and benefits before submission</li><li>Review patient records, clinical documents, and physician orders</li><li>Submit accurate authorization requests with required medical documentation</li><li>Follow up with insurance companies for pending approvals</li><li>Handle denials and initiate appeals with proper justification</li><li>Maintain accurate records of all authorization activities</li><li>Communicate authorization status with providers, patients, and internal teams</li><li>Ensure compliance with payer policies, CPT/ICD codes, and medical necessity guidelines</li></ul>Required Skills &amp; Qualifications<ul><li>Bachelor&rsquo;s degree (Healthcare Administration, Business, or relevant field preferred)</li><li>1&ndash;3 years of experience in Prior Authorization / Medical Billing / RCM</li><li>Strong knowledge of:</li><li>Insurance verification</li><li>Prior authorization process</li><li>Medical terminology</li><li>CPT &amp; ICD-10 coding</li><li>Excellent communication and coordination skills</li><li>Strong attention to detail and time management</li><li>Ability to work in a fast-paced, target-driven environment</li><li>Proficiency in MS Office and healthcare software (EMR/EHR systems)</li></ul>Key Competencies<ul><li>Analytical &amp; problem-solving skills</li><li>Multitasking ability</li><li>Strong follow-up and negotiation skills</li><li>Customer service orientation</li><li>Ability to meet deadlines and SLAs</li></ul>KPIs / Performance Metrics<ul><li>Authorization approval rate</li><li>Turnaround time (TAT)</li><li>First-pass success rate</li><li>Accuracy &amp; compliance</li><li>Daily productivity targets</li></ul>Working Conditions<ul><li>Night shift / US healthcare shift</li><li>Office-based</li></ul>Career Path<ul><li>Prior Authorization Executive</li><li>Senior Authorization Executive</li><li>Team Lead &ndash; Authorization</li><li>RCM Manager</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs60,000.00 per monthWork Location: In person

Prior Authorization Executive

Top Line Resource Group (TLRG)

Location: DHA Phase 8, Lahore [Onsite]Employment Type: Full-timeWork Timing: 05 PM &ndash; 02 AM Pakistan Time (US Business Hours)Job OverviewTopline Resource Group (TLRG) is seeking a dedicated Eligibility &amp; Authorization Specialist to manage the critical front-end operations for our US-based healthcare clients. This role is focused entirely on securing the financial foundation of the practice by ensuring every patient has active coverage and every procedure has the required clinical approval before services are rendered.Key Responsibilities<ul><li>Verify patients' insurance coverage and eligibility in real-time to ensure policies are active and services are covered on the specific Date of Service (DOS).</li><li>Obtain pre-authorizations from insurance companies for medical procedures and treatments.</li><li>Communicate directly with patients regarding their insurance status, coverage specifics, and any required actions or out-of-pocket responsibilities.</li><li>Maintain accurate and meticulous records of insurance verifications and authorizations, including representative names and unique reference numbers for audit trails.</li><li>Collaborate with healthcare providers to ensure all necessary clinical information, physician notes, and CPT/ICD-10 codes are obtained for successful pre-authorizations.</li><li>Monitor and follow up on pending authorizations daily to ensure timely processing and stay within the 7&ndash;10 day payer response window.</li><li>Analyze insurance benefits to identify exact copays, unmet deductibles, and co-insurance percentages to ensure accurate front-end collections.</li><li>Identify if the provider is in-network or out-of-network and determine if specific plan tiers (HMO/EPO) require a PCP referral before the visit.</li><li>Stay up to date with insurance policies, CMS regulations, and HIPAA guidelines to ensure 100% compliance across all US healthcare accounts.</li><li>Track and manage KPIs, including the clean claim rate and authorization turnaround time, to reduce AR aging and increase collection rates.</li></ul>Required Qualifications<ul><li>3+ years of experience in US Medical Billing, specifically focused on Front-End operations (Eligibility and Authorizations).</li><li>Expert-level familiarity with CPT, ICD-10, and HCPCS codes and their specific relationship to authorization requirements.</li><li>Deep understanding of US insurance plans, including Medicare, Medicaid, HMO, PPO, and Commercial plans.</li><li>Hands-on experience with EHR/EMR systems, Practice Management software, and major US payer portals (Availity, Navinet, etc.).</li><li>Excellent verbal and written English communication skills for professional interaction with US insurance companies and clinical teams.</li><li>Strong analytical ability to interpret Verification of Benefits (VOB) reports and payer medical necessity criteria to resolve issues before service delivery.</li></ul>Pay: Rs100,000.00 - Rs125,000.00 per monthExperience:<ul><li>eligibility &amp; authorization: 2 years (Required)</li></ul>Work Location: In person

Eligibility & Authorization Specialist

Job Title:Meta Leads Handler &ndash; DME / HealthcareDepartment:Patient Success / DME Sales SupportJob Summary:We are hiring a Meta Leads Handler to manage and qualify incoming leads generated through Facebook &amp; Instagram (Meta Ads) for Durable Medical Equipment (DME) services.The role focuses on quick response, patient qualification, and coordination with intake/sales teams to convert leads into eligible patients under insurance guidelines.Key Responsibilities: Lead Response &amp; Patient Handling<ul><li>Respond to Meta leads via calls, WhatsApp, and Messenger within 2&ndash;5 minutes</li><li>Communicate with patients professionally and empathetically</li><li>Guide patients about DME products/services (e.g., braces, CGM, oxygen, etc.)</li></ul>Patient Qualification (VERY IMPORTANT)<ul><li>Collect and verify:</li><li>Patient demographics (Name, Age, State)</li><li>Insurance type (Medicare, Medicaid, Private)</li><li>Medical condition (e.g., diabetes, back pain, mobility issues)</li><li>Doctor availability / prescription status</li><li>Identify eligible vs non-eligible patients based on DME criteria</li><li>Filter out junk or duplicate leads</li></ul>Intake Support &amp; Documentation<ul><li>Collect initial required information for intake process</li><li>Ensure accurate and complete data entry</li><li>Prepare lead for intake / prior authorization / verification teams</li></ul>Communication &amp; Conversion Support<ul><li>Build trust with patients and explain next steps clearly</li><li>Handle basic objections and concerns</li><li>Ensure maximum show-up / answer rate for follow-ups</li></ul>CRM &amp; Lead Management<ul><li>Update leads in CRM / Google Sheets with:</li><li>Lead status (New, Qualified, Not Interested, Converted)</li><li>Follow-up notes</li><li>Call outcomes</li><li>Maintain proper pipeline hygiene</li></ul>Coordination with Internal Teams<ul><li>Transfer qualified leads to:</li><li>Intake team</li><li>Verification / Prior Authorization</li><li>Sales closers</li><li>Share complete patient details for smooth processing</li></ul>Performance Tracking<ul><li>Maintain:</li><li>Response time under 5 minutes</li><li>High qualification accuracy</li><li>Conversion-ready leads</li></ul>Requirements:<ul><li>Intermediate / Bachelor&rsquo;s degree</li><li>Experience in DME / Healthcare / Medical Billing / Patient Handling preferred</li><li>Knowledge of:</li><li>Medicare &amp; insurance basics</li><li>Patient intake process</li><li>Fresh candidates with strong communication can also apply</li></ul>Required Skills:<ul><li>Strong English communication (US accent preferred)</li><li>Patient dealing &amp; empathy</li><li>Lead qualification skills</li><li>Fast typing &amp; multitasking</li><li>Basic knowledge of healthcare workflow</li></ul>Job Type:<ul><li>Full-time</li><li>Night Shift (US Campaigns)</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Meta Leads handler Female with good Communication

Explore 401+ Prior authorization specialist in Lahore this April. Find roles across top companies and apply now to boost your career.

401 prior authorization specialist jobs In Lahore

Prior Authorization Specialist

Prior Authorization Specialist & Team Lead

Prior Authorization Specialist

Authorization Specialist

Prior Authorization Executive

Eligibility & Authorization Specialist

Meta Leads handler Female with good Communication