We are looking for an experienced Prior Authorization Quality Analyst (QA) with strong expertise in Cardiology specialty. The candidate will be responsible for monitoring and evaluating Prior Authorization processes to ensure accuracy, compliance with payer guidelines, and adherence to quality standards.
Key Responsibilities:
Perform quality audits on Prior Authorization cases handled by associates.
Review authorization requests for accuracy, completeness, and compliance with payer guidelines.
Identify errors, process gaps, and areas of improvement.
Provide constructive feedback and coaching to team members to improve performance.
Maintain quality scorecards, audit reports, and share insights with management.
Ensure adherence to client requirements, TAT, and internal quality standards.
Conduct refresher sessions and support process improvement initiatives.
Work closely with operations and training teams to maintain quality benchmarks.
Required Skills:
Strong knowledge of US Healthcare Prior Authorization processes.
Expertise in Cardiology specialty workflows and payer requirements.
Good understanding of medical terminologies, CPT/ICD codes, and insurance guidelines.
Excellent analytical, auditing, and feedback skills.
Ability to maintain quality metrics and reporting.
Eligibility Criteria:
5–7 years of experience in US Healthcare Prior Authorization.
Prior Authorization QA experience is mandatory.
Cardiology specialty experience is required.
Strong communication and documentation skills.
Interested candidates with relevant experience can apply for this job so that we can contact you directly.
