Role & Responsibilities

• Review clinical documents, determine authorization requirements, and submit prior authorization requests to insurance payers.
• Follow up with payers to ensure timely approvals and maintain accurate authorization records.
• Coordinate with providers to obtain required clinical information and ensure compliance with payer guidelines.
• Communicate authorization status to internal teams and support AR/RCM teams to reduce authorization-related denials.
• Resolve payer issues, assist with appeals, and ensure compliance with HIPAA and organizational standards.

Skill Sets

• 1–4 years of experience in Prior Authorization, Pre-Certification, or Utilization Management (US Healthcare).
• Strong understanding of US insurance payers, CPT/ICD codes, medical necessity guidelines, and RCM workflows.
• Good communication skills.
• Experience with payer portals such as Availity, Optum, Aetna, etc.
• Ability to multitask, prioritize, and meet turnaround deadlines.
• Familiarity with EHR / Practice Management systems is a plus.
• Comfortable working in Night Shift.

Description

• Immediate joiner or up to 15 days notice period.
• Work From Office.
• 5 working days with fixed weekend off.

Location

Plot 27, Siruseri IT Park, Project Office, A-40, First Cross Road,
Siruseri, Tamil Nadu 603103