Prior Authorization Specialist-US Healthcare

4 weeks ago

New Delhi, India Macro Outsourcing Full time

Company Description

Macro Outsourcing Private Limited is a leading Business Process Outsourcing (BPO) firm specializing in supporting US-based doctors and healthcare practices. We provide services such as medical records management, appointment scheduling, Medical Scribing and administrative support, with a focus on ensuring efficient patient care for our clients.

Role Description

We are seeking a skilled and detail-oriented Prior Authorization Specialist to join our team. This will be the full time on-site role for which you will be responsible for obtaining prior authorizations for referrals, procedures, medications, and other medical services for doctor's offices in the United States, which are clients of Macro Outsourcing. This critical role requires knowledge of US healthcare regulations, insurance requirements, and prior authorization processes.

Key Responsibilities

  • Prior Authorization Requests: Initiate and follow up on prior authorization requests for procedures, medications, and specialist referrals as required by various insurance providers.
  • Documentation Management: Gather necessary medical documentation and patient information required for successful prior authorizations.
  • Insurance Verification: Confirm patient insurance eligibility and determine specific requirements for prior authorizations based on the insurer.
  • Communication: Liaise with insurance companies, healthcare providers, and relevant parties to resolve authorization issues and to expedite the approval process.
  • Tracking & Reporting: Monitor the status of prior authorization requests, maintain accurate records of interactions, and update the healthcare provider on any approval or denial outcomes.
  • Compliance: Adhere to HIPAA guidelines and other US healthcare regulations regarding patient information and data security.

Qualifications

  • Experience: At least 2+ years of experience in prior authorization, medical billing, or related roles within the US healthcare system.
  • Knowledge: Familiarity with US insurance companies, authorization processes, medical terminology, and HIPAA regulations.
  • Technical Skills: Proficiency in medical billing software and other healthcare management platforms; strong knowledge of Microsoft Office Suite (Excel, Word).
  • Communication Skills: Excellent verbal and written communication skills in English for effective interaction with US-based clients and insurers.
  • Attention to Detail: High degree of accuracy and meticulous attention to detail, particularly when managing patient data and insurance documentation.

Job Location

Safdarjung Enclave, New Delhi

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