Job Description

Authorization Specialist - Revenue Cycle Management (RCM)

Location:

[Insert Location]

Department:

Revenue Cycle Management

Reports to:

RCM Manager / Supervisor

Job Summary:

The Authorization Specialist plays a critical role in the healthcare revenue cycle by obtaining prior authorizations, referrals, and approvals from insurance companies to ensure timely and accurate processing of patient services. This position requires strong knowledge of insurance policies, excellent communication skills, and the ability to navigate insurance portals efficiently to support revenue integrity and minimize claim denials.

Key Responsibilities:

Obtain prior authorizations, referrals, and approvals for scheduled procedures and treatments from insurance payers. Verify patient insurance coverage and benefits related to authorization requirements. Collaborate with clinical staff, providers, and insurance companies to ensure all necessary documentation is submitted and received. Maintain accurate records of all authorizations, denials, and appeals in the RCM system. Communicate authorization status to relevant internal departments, including scheduling, billing, and patient financial services. Research and resolve insurance-related issues affecting prior authorizations. Assist in appeals and resubmissions for denied or delayed authorizations. Monitor authorization timelines to ensure compliance with payer requirements and internal performance standards. Stay up to date with changes in payer policies and insurance regulations. Provide support and training to team members on authorization processes and system use. Contribute to improving authorization workflows and reducing delays in the revenue cycle.
Qualifications:

High school diploma or equivalent required; Associate's or Bachelor's degree preferred. Previous experience in healthcare authorization, billing, or revenue cycle management preferred.
Job Type: Full-time

Pay: ₹21,000.00 - ₹45,000.00 per month

Work Location: In person