Healthcare Authorization Professional
3 weeks ago
Nexgenhiringexperts is seeking a highly skilled Healthcare Authorization Professional to join our team in Bangalore, India. As a Prior Authorization Specialist, you will play a critical role in ensuring that medical procedures are authorized and delivered efficiently.
Key Responsibilities:- 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.
- 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.
- 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).
- 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.
- 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 understanding and applying 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.
- Location: Bangalore, India.
- Employment Type: Full-time.
- Schedule: Regular working hours, with potential requirements for additional hours based on workload.
We offer a competitive salary range of 45,000 - 60,000 per month, commensurate with experience. If you are detail-oriented, proactive, and capable of managing multiple priorities, we encourage you to apply for this role.
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