Prior Authorization Specialist

AuraRCM & Consulting Inc.; Chennai District; On-site; INR 300,000 - 540,000; Full time

Job summary

AuraRCM & Consulting Inc. is seeking a detail-oriented prior authorization specialist to handle intake reviews, payer submissions, and denial management with clinical coordination. The role emphasizes accuracy, timely follow-up, and documentation within the practice management ecosystem.

The candidate will collaborate with doctors, nurses, and staff to ensure compliant submissions and high-quality authorization turnaround times, contributing to optimal patient access and payer satisfaction.

Qualifications

• Review prior authorization requests ensuring patient demographics and coverage are correct.
• Identify and gather necessary medical documentation and codes for submission.
• Stay updated on payer policies and coding changes affecting approvals.

Responsibilities

• Intake and review requests for prior authorization with accuracy.
• Submit and track authorization requests via payer portals, fax, or phone.
• Coordinate with clinical staff to obtain documents and physician signatures.

Skills

Intake & Review

Payer Submission

Clinical Communication

Follow-up & Tracking

Denial Management

Documentation & Reporting

Compliance & Knowledge

Productivity & Quality

Job description

• Intake & Review: Receive and review requests for prior authorization, meticulously checking patient demographics, insurance coverage, medical necessity documentation, and scheduled CPT/ICD codes.
• Payer Submission: Initiate, submit, and track authorization requests accurately via payer portals, fax, or phone, adhering strictly to each payer's specific submission guidelines and deadlines.
• Clinical Communication: Collaborate closely with clinical staff (doctors, nurses, medical assistants) to obtain necessary documentation, clinical notes, and physician signatures required for authorization submission and appeals.
• Follow-up & Tracking: Proactively manage the entire PA workflow, conducting timely follow-up with insurance companies to monitor the status of pending authorizations.
• Denial Management: Identify, document, and manage authorizations that are initially denied. Prepare documentation for appeals or peer-to-peer review processes as instructed by the client.
• Documentation & Reporting: Accurately log all authorization status updates, approval numbers, validity dates, and denial reasons in the client's practice management system or tracking tool.
• Compliance & Knowledge: Stay updated on changing payer authorization policies, coverage criteria, and procedure code changes that impact the approval process.
• Productivity & Quality: Meet daily productivity goals and maintain a high quality of authorization accuracy and turnaround time (TAT).