Prior Authorization Specialist

7 days ago

Lahore, Punjab, Pakistan Blue Health Full time 900,000 - 1,200,000 per year

Blue Health is seeking a
Prior Authorization Specialist
(also known as
Clinical Authorization Coordinator
) with a
medical or allied health science background
for a
non-clinical role
supporting our
prior authorization process
. This position combines healthcare expertise with cutting-edge technology and offers a dynamic, innovation-driven environment modeled on US healthcare standards.

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
    HIPAA
    and
    payer-specific requirements
    .
  • Coordinate with physicians, pharmacists, and healthcare providers to obtain supporting documentation.
  • Maintain accurate case records in
    EHR/EMR systems.
  • Support
    appeals and denials
    management when required.
  • Leverage
    AI-based tools
    to streamline authorization workflows and improve decision-making efficiency.

Requirements:

  • Background in
    Nursing, Pharmacy, or Allied Health Sciences
    (RN, LPN, BSN, PharmD, CPhT, or equivalent).
  • Strong understanding of
    medical terminology
    and
    payer guidelines
    .
  • Prior experience in
    utilization management
    ,
    authorization
    , or
    clinical review
    is highly preferred.
  • Excellent communication, organizational, and analytical skills with attention to detail.

Qualifications:

  • Bachelor's degree in
    Nursing, Pharmacy, Allied Health
    , or equivalent clinical field.
  • Preferred:
    MBBS, DPT, or PharmD.
  • Ability to work
    independently in a fast-paced, tech-enabled environment
    .
  • Familiarity with
    EHR/EMR systems
    and
    insurance workflows
    .

Why Blue health:

  • Exposure to
    cutting-edge AI tools
    that enhance efficiency, learning, and communication.
  • At
    Blue Health
    , your accent naturally improves through regular communication practice, supporting success in international healthcare language exams.
  • Professional connections
    and
    internship opportunities
    in the
    US healthcare system
    .
  • A culture that
    rewards innovation
    , encourages
    creative development
    , and recognizes individual contribution.
  • No-boss culture
    work in a flat, collaborative structure focused on mentorship and growth.
  • Experience a
    US-style work environment
    blending healthcare operations and continuous learning.

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