Medical Billing Pre-Authorization Process associate/TL/Manager

Role & responsibilities

Please find below Key Responsibilities of prior Authorization process.

• Obtain prior authorizations from insurance providers for medical procedures, diagnostic tests, surgeries, and prescription medications.
• Review patient medical records and clinical documentation to ensure that prior authorization requests meet insurance requirements.
• Communicate with healthcare providers, insurance companies to gather the necessary information for authorizations.
• Track the status of authorization requests and follow up with insurance companies on pending approvals or denials.
• Resolve authorization issues, appeals, and discrepancies in a timely manner.
• Document all activities related to prior authorization in the medical billing system.
• Ensure compliance with HIPAA and other regulatory requirements.
• Stay updated on insurance guidelines and authorization protocols for various payers.

Preferred candidate profile

• Experience with prior authorization
• Should have RCM knowledge
• Comfortable with night shift

Perks and benefits

As per industry standard