Job Description

- Associate, Inpatient Prior Authorization

Associate - Inpatient Prior Authorization

Department: Revenue Cycle Management / Utilization Management
Reports To: Team Lead - Prior Authorization / Prior Authorization Supervisor
Job Level: Associate / Entry to Mid-Level
Work Location: RMZ, Hi-Tech city Hyderabad
Employment Type: Full-time

Position Summary

The Associate - Inpatient Prior Authorization is responsible for verifying insurance coverage, initiating, obtaining, and tracking inpatient authorizations for hospital admissions, continued stays, and post-acute transitions. The associate ensures that all required authorizations are secured before or during a patient's hospital stay, in compliance with payer policies, to prevent claim denials and delays in reimbursement.

Key Responsibilities

Review inpatient admissions and identify cases requiring prior authorization based on payer rules and plan benefits.
Initiate inpatient authorization requests through payer portals (e.g., Availity, NaviNet, Optum, UHC Link, etc.) or via phone/fax.
Submit medical documentation (H&P, clinical notes, diagnostic reports) to support medical necessity review.
Obtain initial admission approvals and ensure concurrent/continued stay authorizations are updated before expiration.
Verify authorization details (auth number, date span, approved services) and record accurately in EMR (EPIC, Cerner, Meditech, etc.).
Communicate with payer representatives to follow up on pending authorization requests.
Coordinate with Utilization Review Nurses and Case Managers to gather clinical updates for concurrent reviews.
Maintain logs for pending, approved, denied, and appealed authorization requests.
Assist the denials management team by providing authorization information for appeals.