Prior Authorization Specialist

Role & responsibilities

Prior Authorization Specialist Job Description

• Review Medical Records

A Prior Authorization Specialist meticulously examines patient records to determine if treatments, procedures, or medications require prior authorization, ensuring that each case is assessed accurately.

• Insurance Verification

A Prior Authorization Specialist confirms patient insurance details, verifying that the coverage is in place for the proposed healthcare services. This involves a deep understanding of various insurance plans and their coverage details.

• Authorization Requests

These professionals are responsible for preparing and submitting detailed authorization requests to insurance companies, complete with all necessary documentation.

• Collaboration

A Prior Authorization Specialist works closely with healthcare providers to collect necessary clinical information, streamlining the authorization process.

• Monitoring and Follow-ups

They keep track of authorization requests, follow up with insurance companies, and keep detailed records of all communications.

• Denial Management

Also, a Prior Authorization Specialist investigates insurance denials, resubmit requests, and appeal when needed to ensure that patients receive the care they require.

• Patient Communication

They explain the prior authorization process to patients, including any potential delays and financial implications.

Preferred candidate profile - MBBS, Any Foreign MBBS degree, BHMS, BAMS, B.Pharm, M.Pharm, D.Pharm

Night shift 9 pm to 6 am

Skills required - Clinical Documentation review, Diagnosis assessment, Preparation of Prior Authorization form and submit to Insurance companies

Preferably we will consider freshers who completed B.Pharma, M Pharma