SR Prior Authorization

Sutherland; Uppal; On-site; INR 279,000 - 469,000; Full time

Benefits offered by this job

Night shift allowance

Fixed week offs

Cab facility

Transport allowance

Job summary

Sutherland in Hyderabad (Uppal) is seeking an Experienced Prior Authorization Specialist to manage the authorization process for medical services, procedures, medications, and treatments. This role requires verifying insurance requirements, submitting authorization requests, and following up with payers to ensure timely approvals.

You will work with clinical teams, handle documentation in EMR/EHR systems, and aim to meet productivity and quality targets while maintaining HIPAA compliance.

Qualifications

• Experience with US healthcare prior authorization processes.
• Ability to review clinical documentation and explain requirements to payers.
• Familiarity with CPT/HCPCS, ICD-10 codes and medical necessity.

Responsibilities

• Verify insurance eligibility and benefits.
• Determine whether prior authorization is required and submit requests.
• Collect and review clinical documentation for authorizations.
• Communicate with payers, providers and clinical teams.
• Track authorization statuses and timelines; manage denials/appeals.

Skills

Prior authorization

US healthcare knowledge

Communication skills

Attention to detail

EMR/EHR proficiency

Excel

Outlook

Tools

EMR/EHR systems

Payer portals

MS Excel

MS Outlook

Job description

Greeting from Sutherland,

We are currently hiring Experienced PRIOR AUTHORIZATION for our Hyderabad locations (Uppal ). If you are looking for a new opportunity or know someone who would be a great fit, please share this opening within your network.

Job Title: Prior Authorization Specialist
Department: Healthcare Operations / Medical Billing
Experience: 2 TO 4 years (preferred)
Location: Hyderabad - Uppal
Employment Type: Full-time

Job Summary

We are looking for a detail-oriented Prior Authorization Specialist to manage the authorization process for medical services, procedures, medications, and treatments. The role involves verifying insurance requirements, submitting authorization requests, following up with payers, and ensuring timely approvals to avoid delays in patient care.

Key Responsibilities

• Verify patient insurance eligibility and benefits.
• Determine whether prior authorization is required for specific services or procedures.
• Prepare and submit prior authorization requests to insurance companies.
• Collect and review required clinical documentation, medical records, and supporting information.
• Communicate with insurance companies, providers, and clinical teams regarding authorization status.
• Track pending, approved, denied, and expired authorizations.
• Follow up with payers to obtain authorization decisions within required timelines.
• Identify authorization denials and assist with appeals or reconsideration requests.
• Maintain accurate documentation in the appropriate systems.
• Ensure compliance with payer guidelines, HIPAA/privacy requirements, and organizational policies.
• Meet productivity, accuracy, turnaround-time, and quality targets.

Required Skills

• Knowledge of US healthcare insurance and prior authorization processes.
• Understanding of medical terminology and basic clinical documentation.
• Familiarity with insurance payers, CPT/HCPCS codes, ICD-10 codes, and medical necessity.
• Strong written and verbal communication skills.
• Good analytical and problem-solving abilities.
• Excellent attention to detail and organizational skills.
• Ability to work with EMR/EHR, payer portals, and authorization platforms.
• Proficiency in MS Office, particularly Excel and Outlook.

Perks & Benefits:

• Night Shift Allowance 100 per working day
• Fixed Week Offs Saturday & Sunday
• Two-way Cab Facility (within a 25 km radius)
• Self-Transportation Allowance up to 3,500