L2- Rcm Associate

3 days ago

Vellore, India Wonderworth Solutions Full time

**Job Summary**:
**Key Responsibilities**:

- **Prior Authorization**: Manage and process prior authorization requests for medical services and procedures, ensuring all necessary documentation is submitted accurately and promptly.
- **Verification**: Verify insurance benefits and coverage requirements to determine the need for prior authorization and ensure compliance with payer guidelines.
- **Communication**: Communicate with healthcare providers, insurance companies, and patients to obtain necessary information, follow up on authorization status, and resolve any issues.
- **Documentation**: Maintain detailed records of all prior authorization requests, approvals, and denials, ensuring compliance with internal policies and payer requirements.
- **Follow-Up**: Monitor and track the status of authorization requests, addressing any delays or issues to expedite approvals.
- **Compliance**: Ensure adherence to relevant regulations, payer guidelines, and company policies regarding prior authorization processes.
- **Reporting**: Generate and review reports related to prior authorization activities, identifying trends and areas for improvement.
- Should have 2 years of experience in medical billing, preferably in the prior authorization.
- Anatomy Physiology & Medical Terminology.
- Excellent ability to read and interpret comprehensive documents.
- Minor ability to research and demonstrate patience.
- Formal compliance.
- Exhaustive reading skills for thorough review of authorization requests and related documentation.

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