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Referral Authorization Specialist

1 month ago

delhi, India Regal Outsource (India) Private Limited Full time
Summary:
A Referral Authorization Specialist oversees both patient referrals and authorization processes in a healthcare setting. Key responsibilities include obtaining pre-authorizations from insurance companies, managing referral documentation, and ensuring that patients are scheduled appropriately with specialists or for diagnostic services. They function as liaisons between healthcare providers, insurance companies, and patients to ensure smooth coordination of care. This role typically requires knowledge of medical terminology, insurance verification processes, and excellent communication skills, with experience in healthcare or customer service settings being highly beneficial.
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.
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)
Key Competencies:
Leadership & Team Management
Analytical Skills
Attention to Detail
Problem Solving
Time Management
Shift - US Timings/ Night Shift
What We Offer:
Competitive salary and benefits
Opportunity to work with a dynamic and growing team
Career development opportunities
Work-life balance initiatives
Interested candidates can send your resume and cover letter on