Healthcare Eligibility & Authorization Specialist

Edge; Pakistan; On-site; PKR 8,886,000 - 14,996,000; Full time

Job summary

Edge is recruiting a Medical Administrative Assistant to support US-based healthcare providers. The role requires experience with scheduling, eligibility verification, and prior authorizations, and involves acting as a liaison between patients, providers, and insurers.

The candidate will navigate insurance portals and EHRs to ensure timely access to care, manage authorizations, and communicate clearly in English in a fast-paced environment.

Qualifications

• 1 year of direct US healthcare scheduling, eligibility, prior authorization and verification experience.
• Deep understanding of PPO, HMO, Medicare/Medicaid concepts.
• Proficient with insurance portals and EHR/practice management systems.

Responsibilities

• Conduct eligibility checking and benefits verification for patients prior to appointments.
• Interpret insurance policies (PPO/HMO/Medicare/Medicaid) accurately.
• Determine patientFinancial responsibilities incl. deductibles, copays, coinsurance; document findings in PM system.
• Submit prior authorization requests via web portals, fax, or phone.
• Review clinical documentation to ensure medical necessity before submission.
• Track status of pending authorizations and expedite urgent requests.
• Handle inbound/outbound calls to schedule and remind patients.

Skills

US healthcare experience

English communication

Attention to detail

Analytical skills

Independent worker

Fast-paced environment

Tools

Availity

Optum

CoverMyMeds

ECW

Tebra

Dentrix

Job description

Edge is recruiting a Medical Administrative Assistant to support US-based healthcare providers. The role requires experience with scheduling, eligibility verification, and prior authorizations, and involves acting as a liaison between patients, providers, and insurers.

The candidate will navigate insurance portals and EHRs to ensure timely access to care, manage authorizations, and communicate clearly in English in a fast-paced environment.