Prior Authorization Senior Associate/QA/Teal Leader

2 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

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