Eligibility & Authorization Specialist

3 days ago

Islamabad, Islamabad, Pakistan Tasklypro Technologies Full time
Role Overview:

We are seeking a proactive and detail-oriented Eligibility & Authorization Specialist to join our front-end medical billing team. This role is focused on Insurance Eligibility & Benefits Verification and Prior Authorization Management. The ideal candidate will ensure that patient insurance details are accurately verified and that required pre-authorizations are obtained in a timely manner to support clean claim submissions and faster reimbursements.

Key Responsibilities:
  • Verify insurance eligibility and benefit coverage using payer websites and clearinghouse portals
  • Contact insurance carriers via phone or online systems to confirm patient benefits and pre-authorization requirements
  • Prepare and submit prior authorization requests to payers based on scheduled procedures and clinical documentation
  • Track and follow up on pending authorizations to ensure timely approvals
  • Communicate effectively with U.S.-based provider offices regarding missing information or payer responses
  • Maintain organized records of all eligibility checks and authorization requests
  • Escalate complex cases or delays to supervisors with proper documentation
  • Ensure all processes comply with HIPAA and payer-specific guidelines
Qualifications:
  • 1–2 years of experience in U.S. medical billing, eligibility verification, or prior authorization
  • Knowledge of commercial payers, Medicare, and Medicaid requirements
  • Familiarity with tools like Availity, payer portals, and EHR systems
  • Strong communication skills and fluency in English (written and spoken)
  • Excellent attention to detail and ability to manage time-sensitive tasks
  • Understanding of HIPAA compliance and patient privacy protocols
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