Prior Authorization Specialist (US Healthcare)

Job details

Prior Authorization Specialist (US Healthcare)

Key Responsibilities:

Manage end-to-end Prior Authorization processes for both medical services and medication authorizations.
Verify patient insurance eligibility, benefits, and coverage.
Submit, monitor, and follow up on prior authorization requests with insurance providers.
Process and track medication prior authorizations through CoverMyMeds.
Coordinate with physicians, clinics, and internal teams to obtain required clinical documentation.
Track authorization status and ensure timely approvals to avoid delays in patient care.
Maintain accurate records and update authorization details in the practice management/EHR system (eClinicalWorks)
Ensure compliance with payer guidelines, client requirements, and HIPAA regulations.
Review authorization denials, prepare appeals or resubmissions, and follow up until resolution.
Communicate authorization updates to clients and internal stakeholders as needed.

Required Qualifications:

1–3+ years of experience in US Healthcare Prior Authorization.
Strong understanding of insurance verification, payer guidelines, and authorization workflows.
Hands-on experience with CoverMyMeds for medication prior authorizations would be an added advantages. Not Mandatory.
Excellent communication, analytical, and follow-up skills.
Ability to manage multiple tasks while meeting turnaround time (TAT) requirements.
Proficiency in Microsoft Office (Excel, Outlook, Word).

Preferred Qualifications:

For employee benefits & job-related queries, contact HR: +91 95103 36856 | 73598 06462

Pay: ₹25,000.00 - ₹45,000.00 per month

Benefits:

Work Location: In person