Medical Billing Specialist for US Healthcare

5 days ago


Noida, Uttar Pradesh, India Vistec Partners Full time

Job Overview

Vistec Partners is seeking a highly skilled Medical Billing Specialist to join our team as an Authorization (Auth) and Pre-Authorization (Pre-Auth) Specialist in the US healthcare Revenue Cycle Management (RCM) department.

This role is crucial in ensuring that patients receive timely and necessary medical care while navigating the complexities of insurance and authorization processes. As an MBBS doctor, you will work closely with healthcare providers, insurance companies, and patients to gather and confirm required information.

Key Responsibilities:

  • Evaluate prior authorization requests for various medical services, procedures, and medications.
  • Ensure that all necessary clinical documentation is provided to support the medical necessity of the requested services.
  • Confirm patient insurance benefits and eligibility through comprehensive intake processes.
  • Communicate with insurance companies to verify coverage and obtain necessary authorizations.
  • Maintain accurate records of all prior authorization requests, including approvals and denials.
  • Document all interactions and decisions in the electronic health record (EHR) system.
  • Liaise with healthcare providers, insurance companies, and patients to gather and confirm required information.
  • Provide clear and concise information to patients regarding their authorization status and any potential barriers to care.
  • Keep abreast of changes in insurance policies, regulatory requirements, and procedural guidelines specific to healthcare.
  • Ensure compliance with all relevant laws and regulations.

Required Skills and Qualifications:

  • Exceptional attention to detail and ability to scrutinize documentation.
  • Strong verbal and written communication skills for effective collaboration with healthcare professionals and insurance representatives.
  • Proficient analytical skills in evaluating medical necessity and substantiating requests based on clinical criteria.
  • Ability to manage multiple requests simultaneously while adhering to strict deadlines.
  • Skill in navigating complex issues to secure necessary authorizations.
  • Familiarity with electronic health records (EHR) and medical billing software.
  • MBBS degree with additional training or certification in medical billing and coding, if possible.
  • Prior experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities is preferred.


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