Prior Authorization Specialist - US RCM Healthcare Domain

Sukhvarsha Management Services; Chennai; On-site; INR 342,000 - 570,000; Full time

Job summary

Sukhvarsha Management Services is seeking a Prior Authorization Specialist for night shift in Chennai. The role requires 1+ years of experience in processing prior authorizations and handling US insurance.

Key duties include reviewing medical records, verifying insurance status in real time, and ensuring compliant documentation. Immediate joiners are preferred.

Qualifications

• Minimum 1+ years of experience in a prior authorization role.
• Experience with US insurance processes is preferred.
• Familiarity with Electronic Health Records (EHR) is desirable.

Responsibilities

• Initiate, complete and follow up on prior authorization requests for medical services and procedures with US insurers.
• Review and analyze medical records to identify diagnoses, treatment plans, and physician notes.
• Verify patient insurance coverage and real-time status via portals or payer contact.
• Document authorization details accurately in the system following guidelines.
• Identify and resolve discrepancies in authorization information and escalate complex cases as needed.

Skills

Prior Authorization

US Insurance

Electronic Health Records

Job description

Role

• Position: Prior Authorization Specialist
• Location: Chennai
• Experience required: Minimum 1+ years of experience
• CTC : Max 570000 LPA
• Shift: Night Shift .
• Immediate Joiners Preferred

Key Responsibilities

• Authorization Management: Initiate, complete, and follow up on prior authorization requests for medical services/procedures with US insurance companies.
• Medical Record Analysis: Navigate Electronic Health Records (EHR) to identify diagnose, treatment plans, lab results and physician notes.
• Insurance Verification: Confirm patient insurance coverage, active status and real-time verification via online portals or direct payer contact.
• Documentation & Compliance: Accurately document authorization details in the system while strictly adhering to insurance guidelines.
• Discrepancy Resolution: Identify and resolve errors in authorization information, escalating complex cases when necessary.