BD Analyst

The Prior Authorization Specialist is responsible for obtaining, verifying, and documenting prior authorizations from insurance providers for medical services and procedures. This role ensures all required approvals are secured in a timely manner to prevent service delays, claim denials, and revenue loss. The Specialist acts as a liaison between providers, patients, and insurance companies to streamline the authorization process and ensure compliance with payer requirements.

Authorization Request Management: Initiate and follow up on prior authorization requests for medical services, diagnostic tests, and procedures with insurance companies.
Clinical Information Gathering: Collect and submit necessary medical documentation (e.g., clinical notes, test results) to support authorization requests.
Coordination with Providers: Work closely with physicians, clinical staff, and scheduling teams to obtain required information for submission to payers.
Policy & Coverage Verification: Confirm insurance plan requirements for authorizations, including coverage limitations, medical necessity criteria, and pre-certification rules.
Compliance: Ensure all authorizations are obtained in compliance with payer regulations and organizational policies.

Graduation in any stream.
Strong understanding of insurance authorization processes, payer requirements, and medical necessity criteria.
Experience with prior authorization workflows in a healthcare environment.
Familiarity with insurance plan types (HMO, PPO, EPO, POS) and coverage policies.
Attention to detail and ability to interpret insurance policies and medical documentation.
Minimum of 2 years of experience in prior authorization (Physician Billing) or related healthcare roles.

Immediate joiners welcomed = Bonus - 10000***

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