Clinical Authorization Coordinator

1 day ago


Lahore, Punjab, Pakistan beBeeAuthorization Full time 400,000 - 800,000

We are seeking a skilled professional to support our prior authorization process as a Prior Authorization Specialist.

Job Description

This role involves applying clinical knowledge to review, evaluate, and process medical service requests to ensure they meet payer requirements. The ideal candidate will have a strong understanding of medical terminology and payer guidelines, as well as experience in utilization management or authorization processes.

Key Responsibilities
  • Review prior authorization requests for medical services, procedures, and prescriptions.
  • Apply clinical knowledge and payer guidelines to assess medical necessity.
  • Ensure compliance with regulatory requirements such as HIPAA, CMS, and insurance regulations.
  • Coordinate with healthcare providers to obtain additional documentation.
  • Maintain accurate case records in electronic health record systems.
Required Skills and Qualifications
  • Bachelor's degree in Nursing, Pharmacy, Allied Health, or equivalent clinical field.
  • Knowledge of ICD-10, CPT, and HCPCS coding systems.
  • Prior experience in utilization management or authorization processes is highly preferred.
  • Excellent communication and detail-oriented problem-solving skills.
Benefits
  • Absenteeism is greatly reduced due to the work-from-home arrangements for this position.
Seniority level
  • Entry level
Employment type
  • Full-time
Job function
  • Health Care Provider
Industries
  • Medical Services


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