Pre-Auth Associates - 10th Oct'25

Eclat-Health-Solutions-4; Hyderabad; On-site; INR 300,000 - 500,000; Full time

Job summary

Eclat-Health-Solutions-4 is hiring for the position of Associate in Inpatient Prior Authorization in Hyderabad. This role involves verifying insurance coverage and securing necessary authorizations for hospital admissions and stays.

The ideal candidate will have a high school diploma and experience in healthcare insurance. Strong communication skills and attention to detail are essential.

Qualifications

• High school diploma or equivalent required.
• Experience in healthcare insurance preferred.
• Proficient in using EMR systems.

Responsibilities

• Review inpatient admissions for prior authorization needs.
• Initiate authorization requests through payer portals.
• Verify authorization details and record in EMR.

Skills

Insurance verification

Communication skills

Attention to detail

Education

High school diploma or equivalent

Tools

EMR systems (EPIC, Cerner, Meditech)

Payer portals (e.g., Availity, NaviNet)

Job description

Job Description – Associate, Inpatient Prior Authorization

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.