Prior Authorization Analyst

Prior Authorization Specialist

Job Summary

The Prior Authorization Specialist is responsible for obtaining, verifying, and documenting prior authorizations from insurance providers for medical services and procedures. This role ensures all required approvals are secured in a timely manner to prevent service delays, claim denials, and revenue loss. The Specialist acts as a liaison between providers, patients, and insurance companies to streamline the authorization process and ensure compliance with payer requirements.

Key Responsibilities

• Authorization Request Management : Initiate and follow up on prior authorization requests for medical services, diagnostic tests, and procedures with insurance companies.
• Insurance Communication : Coordinate with insurance providers to verify the necessity and coverage of requested services.
• Clinical Information Gathering : Collect and submit necessary medical documentation (e.g., clinical notes, test results) to support authorization requests.
• Timely Follow-Up : Track authorization requests to ensure timely approvals and address any denials or pending issues proactively.
• Documentation & Record-Keeping : Maintain accurate and complete records of all authorization requests, approvals, and denials in accordance with organizational standards.
• Coordination with Providers : Work closely with physicians, clinical staff, and scheduling teams to obtain required information for submission to payers.
• Denial Management : Identify reasons for authorization denials and work to resolve issues or submit appeals as needed.
• Policy & Coverage Verification : Confirm insurance plan requirements for authorizations, including coverage limitations, medical necessity criteria, and pre-certification rules.
• Payer Portal Utilization : Access and navigate payer portals (Medicare, UHC, BCBS, Availity, Trizetto, etc.) to submit and track prior authorization requests.
• Compliance : Ensure all authorizations are obtained in compliance with payer regulations and organizational policies.

Skills & Qualifications

Interested Candidates please contact us on hanand@nath-mds.com / asood@nath-mds.com / +91 7988003159