Healthcare Authorization Specialist

1 week ago


Bengaluru, Karnataka, India Nexgenhiringexperts Full time
Job Summary

We are seeking a highly skilled Authorization Specialist to join our healthcare team in Bangalore, India. The ideal candidate will possess strong knowledge of medical insurance processes, including CPT and ICD-10 coding, with a primary focus on managing prior authorizations for medical procedures.

Key Responsibilities:
  1. Review and Verification:
  • Assess patient medical history and related documentation to determine the necessity for prior authorizations.
  • Review insurance coverage for patients and verify eligibility.
  • Ensure familiarity with CPT and ICD-10 coding for accurate processing.
Insurance Coordination:
  • Confirm insurance benefits and regularly communicate with insurance companies to submit and manage prior authorizations.
  • Utilize insurance carrier websites and portals (e.g., Evicore, Availity, Cohere) for submitting necessary documents efficiently.
  • Monitor daily authorization status and follow up on pending authorizations by contacting insurance providers as needed.
Documentation and Follow-Up:
  • Submit appeals for denied authorizations and schedule peer-to-peer calls when required.
  • Coordinate with insurance providers to extend authorization dates, request additional units, and process urgent or priority authorizations.
  • Accurately document authorization details, approvals, and denials in the Electronic Health Record (EHR) system (e.g., ECW).
Communication and Issue Resolution:
  • Maintain clear communication with healthcare providers, insurance companies, and patients regarding the authorization process and status.
  • Monitor patient schedules for potential issues and promptly address them with the healthcare office if needed.
  • Respond to calls and correspondence related to patient accounts, providing resolution to inquiries and issues.
Requirements:
  • Education: Graduate degree in a relevant field (Healthcare Administration, Life Sciences, or similar).
  • Experience: Proven experience in prior authorization and medical billing within the healthcare domain.
  • Skills:
    • Proficiency in CPT and ICD-10 coding.
    • Strong organizational skills to track authorizations, submit appeals, and monitor schedules effectively.
    • Ability to use Electronic Health Record (EHR) systems, preferably ECW, and insurance portals.
    • Excellent communication skills and the ability to handle high-pressure situations.
    • Knowledge of insurance carrier policies and prior authorization procedures.
Work Conditions:
  • Location: Bangalore, India.
  • Employment Type: Full-time.
  • Schedule: Regular working hours, with potential requirements for additional hours based on workload.
Estimated Salary:

₹ 45,000 - ₹ 60,000 per month.



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