Prior Authorization Specialist — Fertility/OBGYN & Cardiology

GenMediTech; Pakistan; On-site; PKR 1,116,000 - 1,674,000; Full time

Job summary

GenMediTech is seeking a Prior Authorization Specialist with experience in Fertility/OBGYN and Cardiology to review scheduled services and determine authorization requirements. The role involves submitting requests, following up with payers, and ensuring approvals before the date of service to avoid delays.

Responsibilities include handling authorizations for ultrasounds, labs, genetic testing, IUI, IVF, and related services, as well as echocardiograms and other cardiac procedures.

Qualifications

• Experience in prior authorization, medical billing, or RCM.
• Fertility/OBGYN and/or Cardiology authorization experience preferred.
• Knowledge of CPT, ICD-10, payer portals, referrals, medical necessity, and authorization workflows.
• Strong follow-up, documentation, communication, and attention-to-detail skills.

Responsibilities

• Review scheduled visits, procedures, tests, and treatments to determine prior authorization requirements.
• Submit authorization requests through payer portals, phone, fax, or clearinghouse tools.
• Follow up with insurance companies until approval, denial, or final determination is received.
• Document authorization numbers, approved CPT codes, units, date ranges, payer references, and call details.
• Obtain required clinical documents, orders, notes, test results, and medical necessity support from the clinical team.
• Handle Fertility/OBGYN authorizations for ultrasounds, labs, genetic testing, IUI, IVF, egg retrieval, embryo transfer, procedures, and related services.
• Handle Cardiology authorizations for echocardiograms, stress tests, Holter/event monitors, vascular studies, imaging, and cardiac procedures.
• Review approvals to confirm correct CPT codes, provider, facility, units, and valid date range.
• Escalate pending, denied, urgent, or high-dollar authorization cases to management.
• Coordinate with scheduling, billing, AR, and clinical teams to prevent authorization-related denials.
• Maintain daily tracker for all pending and completed authorization cases.
• Follow HIPAA and patient confidentiality requirements.

Skills

Prior authorization

Medical billing

RCM

Fertility/OBGYN authorization

Cardiology authorization

CPT/ICD-10 knowledge

Payer portals knowledge

Excellent follow-up

Documentation

Communication

Tools

Payer portals

Clearinghouse tools

Job description

We are looking for a Prior Authorization Specialist with experience in Fertility/OBGYN and Cardiology. The candidate will be responsible for reviewing scheduled services, identifying authorization requirements, submitting prior authorization requests, following up with payers, and ensuring approvals are obtained before the date of service to avoid delays and denials.

Key Responsibilities

• Review scheduled visits, procedures, tests, and treatments to determine prior authorization requirements.
• Submit authorization requests through payer portals, phone, fax, or clearinghouse tools.
• Follow up with insurance companies until approval, denial, or final determination is received.
• Document authorization numbers, approved CPT codes, units, date ranges, payer references, and call details.
• Obtain required clinical documents, orders, notes, test results, and medical necessity support from the clinical team.
• Handle Fertility/OBGYN authorizations for ultrasounds, labs, genetic testing, IUI, IVF, egg retrieval, embryo transfer, procedures, and related services.
• Handle Cardiology authorizations for echocardiograms, stress tests, Holter/event monitors, vascular studies, imaging, and cardiac procedures.
• Review approvals to confirm correct CPT codes, provider, facility, units, and valid date range.
• Escalate pending, denied, urgent, or high-dollar authorization cases to management.
• Coordinate with scheduling, billing, AR, and clinical teams to prevent authorization-related denials.
• Maintain daily tracker for all pending and completed authorization cases.
• Follow HIPAA and patient confidentiality requirements.

Requirements

• Experience in prior authorization, medical billing, or RCM.
• Fertility/OBGYN and/or Cardiology authorization experience preferred.
• Knowledge of CPT, ICD-10, payer portals, referrals, medical necessity, and authorization workflows.
• Strong follow-up, documentation, communication, and attention-to-detail skills.
• Ability to manage multiple authorization cases and meet deadlines.

Performance Expectations

• Submit authorizations on time.
• Obtain approvals before scheduled services.
• Reduce authorization-related denials and appointment delays.
• Provide timely updates to billing, scheduling, clinical, and management teams.

Location:Onsite – Satellite Town, Rawalpindi
Employment Type:Full-Time