Job Description

Job Title:

Authorization Specialist - Revenue Cycle Management (RCM)

Job Summary:

The Authorization Specialist plays a vital role in the revenue cycle process by ensuring that prior authorizations are obtained and verified for medical procedures, diagnostic tests, or specialty services. The specialist collaborates with healthcare providers, insurance companies, and patients to reduce delays and denials in reimbursement.

Key Responsibilities:

Obtain prior authorizations for medical services, procedures, surgeries, imaging, and referrals from insurance companies. Confirm authorization requirements based on the patient's insurance plan and the type of service being rendered. Submit authorization requests through payer portals, phone calls, or fax as required. Track the status of submitted authorization requests and follow up with payers until a determination is received. Communicate authorization status to scheduling, clinical, and billing departments. Document all authorization activity in the EHR or practice management system accurately and timely. Ensure compliance with insurance requirements and healthcare regulations (HIPAA, CMS, etc.). Respond to payer denials and re-submit or escalate requests when necessary. Maintain up-to-date knowledge of payer policies and authorization criteria.

Qualifications:

High school diploma or equivalent required; associate degree or healthcare certification preferred. Minimum 1-3 years of experience in medical prior authorization, utilization review, or healthcare billing.
Please share your resume to ssangar@scale-healthcare.in or can call us at 8699557349

Job Type: Full-time

Pay: ?200,000.00 - ?500,000.00 per year

Work Location: In person