Prior Authorization Executive

Suma Soft; Pune District; On-site; INR 420,000 - 660,000; Full time

Job summary

Suma Soft in Pune, India is seeking a healthcare professional to manage prior authorization requests, review clinical documentation, and ensure payer compliance.

You will collaborate with insurance providers to secure timely approvals, escalate issues, and appeal denials when necessary, while maintaining meticulous records of submissions, approvals, denials, and appeals in our systems.

This role requires attention to detail and knowledge of medical criteria and payer processes.

Responsibilities

• Process, monitor, and resolve prior authorization requests.
• Review clinical documentation to ensure compliance with payer requirements and medical necessity criteria.
• Collaborate with insurance providers to ensure timely approvals, elevate issues, and appeal denials when necessary.
• Maintain accurate records of all authorization activities, including submissions, approvals, denials, and appeals.

Job description

Key Responsibilities:

• Process, monitor, and resolve prior authorization requests.
• Review clinical documentation to ensure compliance with payer requirements and medical necessity criteria.
• Collaborate with insurance providers to ensure timely approvals, elevate issues, and appeal denials when necessary.
• Maintain accurate records of all authorization activities, including submissions, approvals, denials, and appeals.