Healthcare Access & Authorization Specialist

Edge; Pakistan; On-site; PKR 4,999,000 - 8,331,000; Full time

Job summary

Edge is seeking a Healthcare Account Representative to support US-based providers, focusing on eligibility checks, prior authorizations, and insurance verification to ensure timely patient access.

As a liaison between patients, clinics, and insurers, you will navigate portals like Availity, Optum, and CoverMyMed(s), and work with EHR/PM systems such as ECW, Tebra, and Dentrix to process requests accurately.

Qualifications

• 1+ year direct US Healthcare experience in scheduling, eligibility, prior authorizations, insurance verification.
• Deep understanding of PPO, HMO, Medicare/Medicaid concepts and patient benefits.
• Proficient at navigating US insurance portals and EHR/practice management systems.

Responsibilities

• Conduct eligibility checks and benefits verification for patients prior to scheduled appointments.
• Interpret insurance policies (PPO/HMO/Medicare) and determine patient financial responsibilities.
• Prepare and submit prior authorization requests via portals, fax, or phone.
• Review clinical docs to ensure medical necessity before submission.
• Track status of authorizations, manage appeals for denied claims, and expedite urgent requests.
• Handle inbound/outbound calls to schedule and remind patients.

Skills

US healthcare experience

Eligibility verification

Prior authorization

Insurance verification

Scheduling in healthcare

English communication

Tools

Availity

Optum

CoverMyMed(s)

ECW

Tebra

Dentrix

Job description

Edge is seeking a Healthcare Account Representative to support US-based providers, focusing on eligibility checks, prior authorizations, and insurance verification to ensure timely patient access.

As a liaison between patients, clinics, and insurers, you will navigate portals like Availity, Optum, and CoverMyMed(s), and work with EHR/PM systems such as ECW, Tebra, and Dentrix to process requests accurately.