Prior Authorization Senior Associate/QA/Teal Leader

4 days ago

Hyderabad, Telangana, India Eclat Health Solutions Full time ₹ 2,50,000 - ₹ 7,50,000 per year

Job Description Associate, Inpatient Prior Authorization

Associate Inpatient Prior Authorization

Department: Revenue Cycle Management / Utilization Management

Reports To: Team Lead Prior Authorization / Prior Authorization Supervisor

Job Level: Associate / Entry to Mid-Level

Work Location: RMZ, Hi-Tech city Hyderabad

Employment Type: Full-time

Position Summary

The Associate Inpatient Prior Authorization is responsible for verifying insurance coverage, initiating, obtaining, and tracking inpatient authorizations for hospital admissions, continued stays, and post-acute transitions. The associate ensures that all required authorizations are secured before or during a patient's hospital stay, in compliance with payer policies, to prevent claim denials and delays in reimbursement.

Key Responsibilities

Review inpatient admissions and identify cases requiring prior authorization based on payer rules and plan benefits.

Initiate inpatient authorization requests through payer portals (e.g., Availity, NaviNet, Optum, UHC Link, etc.) or via phone/fax.

Submit medical documentation (H&P, clinical notes, diagnostic reports) to support medical necessity review.

Obtain initial admission approvals and ensure concurrent/continued stay authorizations are updated before expiration.

Verify authorization details (auth number, date span, approved services) and record accurately in EMR (EPIC, Cerner, Meditech, etc.).

Communicate with payer representatives to follow up on pending authorization requests.

Coordinate with Utilization Review Nurses and Case Managers to gather clinical updates for concurrent reviews.

Maintain logs for pending, approved, denied, and appealed authorization requests.

Assist the denials management team by providing authorization information for appeals.

Qualifications

Education:

  • High School Diploma or equivalent (Required)
  • Associate or bachelor's Degree

Experience:

  • 0–2 years or 2+ of experience in Prior Authorization, Utilization Review, or Hospital Revenue Cycle (Inpatient focus preferred)
  • Experience with payer portals (e.g., Availity, NaviNet, Optum, Cigna, UHC, Aetna)
  • Working knowledge of EMR/EHR systems such as Epic, Cerner, or Meditech

Technical Skills:

  • Familiarity with authorization workflows, ICD-10, CPT/HCPCS, and DRG codes
  • Basic knowledge of payer policies and medical necessity criteria (InterQual, MCG)
  • Proficiency in Microsoft Excel, Word, and Outlook

Core Competencies

Excellent verbal and written communication

Strong organizational and time management skills

Attention to detail and accuracy in documentation

Ability to multitask and manage large caseloads

Team collaboration and coordination with clinical departments

Problem-solving and adaptability in a high-volume environment

Work Environment

  • Work from Office

    • Require flexible to adopt client expectations

  • Prior Authorization

    15 hours ago

    Hyderabad, Telangana, India Intigniz Solutions Full time ₹ 4,58,224 - ₹ 6,00,000 per year

    Prior Authorization Specialist (1+ Years Experience)Responsibilities:Review and process prior authorization requests for medical procedures and medications.Verify insurance eligibility and coverage details.Communicate with providers, payers, and patients for required information.Ensure timely and accurate documentation in systems.Follow up on pending...

  • Prior Authorization Executive

    1 week ago

    Hyderabad, Telangana, India JSD Medical Business Management Services Full time ₹ 4,00,000 - ₹ 12,00,000 per year

    Responsibilities:* Verify patient eligibility and benefits* Ensure compliance with regulatory requirements* Coordinate with healthcare providers and insurers* Manage prior authorization process from start to finishProvident fund

  • Team Lead Hospital Billing Inpatient Prior Authorization

    14 hours ago

    Hyderabad, Telangana, India Eclat Health Solutions Full time US$ 60,000 - US$ 1,20,000 per year

    Hello,Greetings from Eclat Health We are hiring for Team lead Ops - Hospital Billing Prior - AuthorizationJob DescriptionWe are looking for an experienced Team Lead Hospital Billing Inpatient Prior Authorization to lead our growing Pre-Authorization (RCM) team. The ideal candidate will oversee inpatient authorization processes, guide team performance, and...

  • QA Technical Senior Associate

    6 days ago

    Hyderabad, Telangana, India Amgen Inc Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    The QA Technical Senior Associate supports Quality Assurance initiatives across the Quality Operations Network with a primary focus on Technical Writing, Document Management, and Business Performance. This role is responsible for executing key QA documentation processes, system coordination, and project-related administrative functions to ensure compliance...

  • QA Technical Senior Associate

    2 weeks ago

    Hyderabad, Telangana, India Amgen Full time ₹ 12,00,000 - ₹ 24,00,000 per year

    Career CategoryQualityJob DescriptionJob DescriptionThe QA Technical Senior Associate supports Quality Assurance initiatives across the Quality Operations Network with a primary focus on Technical Writing, Document Management, and Business Performance. This role is responsible for executing key QA documentation processes, system coordination, and...

  • Senior Associate

    6 days ago

    Hyderabad, Telangana, India Newport Medical Solutions Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    Job Title: Sr Associate - AuthorizationYears of Experience: 2-3 yearsShift Timings: Night Shift (7:00 PM to 4:00 AM)Mode of operation: Work from the officeMode of Interview: In-PersonLocation: Hyderabad, TelanganaJob DescriptionWe are looking for a senior associate with authorization to join our team. The job requirements are below.Additional CommentsNextGen...

  • Oncology Authorizations Specialist

    2 days ago

    Hyderabad, Telangana, India NexCen Global Inc Full time ₹ 5,00,000 - ₹ 15,00,000 per year

    Role DescriptionThis is a full-time, on-site role for an Oncology Authorizations Specialist, based in Hyderabad. The Specialist will be responsible for securing prior authorizations for oncology services, liaising between healthcare providers and insurance companies, and ensuring compliance with organizational and payer guidelines. Tasks also include patient...

  • Pre-Auth Associates

    2 days ago

    Hyderabad, Telangana, India Eclat Health Solutions Full time ₹ 1,20,000 - ₹ 1,80,000 per year

    Job Description – Associate, Inpatient Prior AuthorizationAssociate – Inpatient Prior AuthorizationDepartment: Revenue Cycle Management / Utilization ManagementReports To: Team Lead – Prior Authorization / Prior Authorization SupervisorJob Level: Associate / Entry to Mid-LevelWork Location: RMZ, Hi-Tech city HyderabadEmployment Type: Full-timePosition...

  • Senior Associate

    2 days ago

    Hyderabad, Telangana, India Q'fleet Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    We are hiring a proactive senior associate to oversee Uber fleet operations. Responsibilities include driver performance tracking, daily payment collection, and ensuring smooth operations. Prior fleet or Uber experience is required.

  • Quality Assurance Principal Associate

    6 days ago

    Hyderabad, Telangana, India Eli Lilly Full time ₹ 12,00,000 - ₹ 24,00,000 per year

    At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our employees around the world work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to our communities...