Prior Authorization Specialist

Accountabilities: Review clinical documentation to ensure all required information is complete, accurate, and ready for authorization submission. Identify and verify appropriate ICD-10 diagnosis codes and CPT procedure codes to support prior authorization requests. Submit authorization requests through insurance payer portals, ensuring all required documentation is included. Monitor and manage pending authorization cases, maintaining accurate records of submission status, outstanding requirements, and follow-up activities. Proactively contact insurance payers to obtain updates, resolve outstanding questions, and help secure timely authorization decisions. Investigate authorization denials, identify the reasons for rejection, and prepare appeals supported by relevant clinical documentation and other required information. Track authorization metrics and maintain clear, organized records to support performance monitoring and workflow improvement. Coordinate with healthcare providers and scheduling teams to communicate authorization statuses, address outstanding requirements, and help prevent delays in appointments or procedures. Follow established procedures and maintain consistent documentation throughout the authorization lifecycle. Requirements Experience in prior authorization, healthcare administration, medical billing, insurance verification, or a related healthcare support function. Experience reviewing clinical documentation for completeness, accuracy, and compliance with submission requirements. Familiarity with ICD-10 diagnosis codes and CPT procedure codes, with an emphasis on identifying and verifying the correct codes rather than extensive medical coding responsibilities. Practical experience submitting prior authorization requests through insurance payer portals. Ability to monitor pending cases systematically and follow up proactively with payers to ensure timely processing. Experience handling authorization denials and preparing appeals with appropriate supporting documentation. Strong organizational skills and attention to detail, particularly when managing multiple requests, deadlines, and case statuses. Ability to track authorization metrics, maintain accurate records, and identify outstanding issues requiring action. Clear written and verbal communication skills, with the ability to coordinate effectively with payers, healthcare providers, and scheduling teams. A proactive, patient-focused approach to problem-solving, with the ability to prioritize tasks and help prevent administrative delays in care. Ability to work independently in a remote environment while following established workflows and maintaining consistent productivity. Benefits Remote work: Full-time remote opportunity for candidates based in India. Healthcare sector experience: Opportunity to contribute to healthcare administration and support timely access to medical services. Professional development: Build and strengthen expertise in prior authorizations, payer processes, clinical documentation, and denial management. Operational impact: Help improve authorization workflows, reduce administrative bottlenecks, and support coordination between healthcare teams. Compensation and additional benefits: Salary, insurance coverage, paid leave, and other specific benefits are not detailed in the available job description.