
Physician Prior Authorization Specialist
3 days ago
Job Description:
Medical DoctorA Medical Doctor is required to manage responsibilities in prior authorization and clinical documentation review. This role is suited for a physician with a strong administrative focus, in-depth knowledge of medical compliance requirements, and excellent command of the English language for documentation and communication.
Key Responsibilities:- Analyze and review medical records for completeness, accuracy, and compliance with payer requirements.
- Execute prior authorization workflows for medications, procedures, and diagnostic tests.
- Audit and validate clinical documentation to support accurate billing and coding.
- Coordinate with insurance portals to verify approvals and billing eligibility when necessary.
- Maintain timely and compliant documentation aligned with CMS and HIPAA guidelines.
- Medical degree (MBBS, MD) from a recognized institution.
- Active and valid medical license (international or domestic).
- Minimum 2 years of hands-on experience in any of the following areas:
- Prior Authorization
- Clinical Documentation Review
- Excellent English communication skills – both written and verbal – are mandatory.
- Proficiency with EHR platforms and billing systems.
- High level of accuracy and consistency in clinical and administrative documentation.
- Ability to work independently during night shifts.
- Fulfilling career as a Medical Doctor.
- Opportunity to work with electronic health records.
- Chance to develop expertise in clinical documentation and prior authorization.
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