Healthcare Authorization Specialist

Company : TGHCO Health Care Private Limited

Location : Hyderabad

As an Authorization (Auth) and Pre-Authorization (Pre-Auth) Specialist in the US healthcare Revenue Cycle Management (RCM), your role would involve several key responsibilities :

Job Description :

Review and Assess Requests :

Evaluate prior authorization requests for various medical services, procedures, and medications.

Ensure that all necessary clinical documentation is provided to support the medical necessity of the requested services.

Verify Insurance Benefits :

Confirm patient insurance benefits and eligibility through comprehensive intake processes.

Communicate with insurance companies to verify coverage and obtain necessary authorizations.

Documentation and Record Keeping :

Maintain accurate records of all prior authorization requests, including approvals and denials.

Document all interactions and decisions in the electronic health record (EHR) system.

Communication :

Liaise with healthcare providers, insurance companies, and patients to gather and confirm required information.

Provide clear and concise information to patients regarding their authorization status and any potential barriers to care.

Stay Updated :

Keep abreast of changes in insurance policies, regulatory requirements, and procedural guidelines specific to healthcare.

Ensure compliance with all relevant laws and regulations.

Training and Mentoring :

Assist in training and mentoring new staff members regarding the prior authorization process and best practices.

Skills Required :

Attention to Detail : Exceptional ability to scrutinize documentation and ensure accuracy in records.

Communication Skills : Strong verbal and written communication for effective collaboration with healthcare professionals and insurance representatives.

Analytical Skills : Proficient in evaluating medical necessity and substantiating requests based on clinical criteria.

Organizational Skills : Ability to manage multiple requests simultaneously while adhering to strict deadlines.

Problem-Solving Skills : Skilled at navigating complex issues to secure necessary authorizations.

Technical Proficiency : Familiar with electronic health records (EHR) and medical billing software

Qualifications :

Education : Any degree with additional training or certification in medical billing and coding, if possible.

Experience : Prior experience in a medical business office or healthcare setting involving customer service or patient-facing responsibilities is preferred

This role is crucial in ensuring that patients receive timely and necessary medical care while navigating the complexities of insurance and authorization processes. If you have any specific questions or need further details, feel free to ask!