AUTHORIZATION SPECALIST

Nexgenhiringexperts; Bengaluru; On-site; INR 300,000 - 520,000; Full time

Job summary

A healthcare staffing firm in Bangalore is seeking an experienced Authorization Specialist to manage prior authorizations for medical procedures. The ideal candidate will possess strong knowledge of CPT and ICD-10 coding, have excellent communication skills, and be detailed-oriented. The position requires a graduate degree in a relevant field and proven experience in the healthcare domain. Interested applicants should send their resume and cover letter to a healthcare staffing firm's email.

Qualifications

• Proven experience in prior authorization and medical billing within the healthcare domain.
• Ability to manage multiple priorities and work under pressure.

Responsibilities

• Assess patient medical history and determine authorization necessity.
• Submit appeals for denied authorizations and handle insurance communications.
• Document authorization details accurately in the EHR system.
• Communicate clearly with healthcare providers, insurance companies, and patients about status and next steps.

Skills

CPT coding

ICD-10 coding

Organizational skills

Communication skills

Insurance carrier policies knowledge

Insurance portals

Organizational skills

Education

Graduate degree in Healthcare Administration or Life Sciences

Tools

Electronic Health Record (EHR) systems

Insurance portals

Job description

Job Summary:
We are seeking an experienced Authorization Specialist to join our healthcare team in Bangalore. This role requires strong knowledge of medical insurance processes, including CPT and ICD-10 coding, with a primary focus on managing prior authorizations for medical procedures. The ideal candidate will be detail-oriented, have excellent communication skills, and be able to work efficiently under pressure.

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) system (e.g., ECW).
• Communication and Issue Resolution
  • Maintain clear communication with healthcare providers, insurance companies, and patients regarding the authorization process and status.
  • Monitor patient schedules for potential issues and promptly address them with the healthcare office if needed.
  • Respond to calls and correspondence related to patient accounts, providing resolution to inquiries and issues.

Requirements:

• Education: Graduate degree in a relevant field (Healthcare Administration, Life Sciences, or similar).
• Experience: Proven experience in prior authorization and medical billing within the healthcare domain.
• Skills:
  • Proficiency in CPT and ICD-10 coding.
  • Strong organizational skills to track authorizations, submit appeals, and monitor schedules effectively.
  • Ability to use Electronic Health Record (EHR) systems, preferably ECW, and insurance portals.
  • Excellent communication skills and the ability to handle high-pressure situations.
  • Knowledge of insurance carrier policies and prior authorization procedures.

Work Conditions:

• Location: Bangalore candidates only
• Employment Type: Full-time
• Schedule: Regular working hours, with potential requirements for additional hours based on workload.

If you are detail-oriented, proactive, and capable of managing multiple priorities, we encourage you to apply for this role.

Application Process:
Please submit your resume along with a cover letter detailing your experience in healthcare authorization to [e-mail] or contact us at 9063238178.