Prior authorization specialist

23 hours ago

Lahore, Punjab, Pakistan Blue Health Full time

Blue Health is seeking an efficient Prior Authorization Specialist to support our clinical and administrative operations. The role involves reviewing medical necessity documentation, verifying insurance eligibility, and obtaining timely prior authorizations for procedures, medications, and therapies. The ideal candidate must possess a strong understanding of healthcare billing practices and insurance workflows and be capable of working independently in a high-volume, fast-paced environment.

Key Responsibilities:
  • Coordinate and obtain prior authorizations from insurance carriers for medications, imaging, procedures, and other clinical services.
  • Review clinical documentation to ensure accuracy and completeness before submission.
  • Communicate with insurance companies, providers, and patients to resolve any authorization issues or denials.
  • Maintain accurate records of prior authorization requests, approvals, and denials within the practice management system.
  • Follow up proactively to ensure all required approvals are received before the scheduled service date.
  • Assist providers and administrative staff with claims appeals and documentation for authorization-related denials.
  • Stay current on payer policies, formularies, and changes in authorization requirements.
Preferred Qualifications:
  • MBBS, DPT, or Pharm D degree preferred.
  • Associate degree or certification in medical billing, healthcare administration, or a related field.
  • Familiarity with major payers (e.g., Medicare, Medicaid, commercial insurance).
  • Ability to interpret medical records, ICD-10, CPT, and HCPCS codes.
  • Experience working with pharmacy benefit managers (PBMs) and specialty medications.
Core Requirements:
  • 1-2 years of prior authorization or medical billing experience in a healthcare setting.
  • Knowledge of insurance verification processes and clinical terminology.
  • Experience with EMR/EHR systems and health insurance portals.
  • Strong communication and interpersonal skills to liaise between healthcare providers and insurance representatives.
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