Prior Authorization Specialist

RNR Global Certification Pvt Ltd; Hyderabad; On-site; INR 250,000 - 450,000; Full time

Job summary

RNR Global Certification Pvt Ltd is seeking experienced Prior Authorization Specialists to obtain authorizations and referrals from insurance companies, verify patient eligibility, and coordinate with payers to secure timely approvals for procedures, surgeries, injections, and DME services.

The role requires attention to detail, strong medical terminology knowledge, and excellent communication with payers and providers to maintain compliant records and smooth workflows.

Qualifications

• Must have experience with prior authorizations and insurance processes.
• Strong understanding of medical terminology.
• Experience coordinating with payers for approvals.

Responsibilities

• Obtain prior authorizations and referrals from insurance companies through payer portals and telephonic communication.
• Verify patient insurance coverage, benefits, and eligibility requirements.
• Review and process authorization requests for procedures, surgeries, injections, and DME.
• Provide required clinical documentation to secure approvals with payers.
• Track, monitor, and update authorization statuses and tasks in the system.
• Follow up with insurance providers on pending authorization requests.
• Maintain accurate records and ensure compliance with payer and organizational standards.

Skills

Medical terminology

Healthcare insurance

Payer communications

Authorization management

Tools

Payer portals

Job description

We are seeking experienced and detail-oriented Prior Authorization Specialists with a strong understanding of medical terminology and healthcare insurance processes. The ideal candidate will be responsible for obtaining prior authorizations and referrals from insurance companies, verifying patient insurance eligibility, and coordinating with payers to ensure timely approvals for procedures, surgeries, injections, and DME services.

Key Responsibilities

• Obtain prior authorizations and referrals from insurance companies through payer portals and telephonic communication.
• Verify patient insurance coverage, benefits, and eligibility requirements.
• Review and process authorization requests for procedures, surgeries, injections, and Durable Medical Equipment (DME).
• Provide insurance companies with the necessary clinical documentation to secure approvals.
• Track, monitor, and update authorization statuses, orders, and tasks in the system.
• Follow up with insurance providers on pending authorization requests.
• Maintain accurate records and ensure compliance with payer and organizational Standards.