Prior Authorization Specialist

2 weeks 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, Pre-Certification Specialist, or Utilization Management Specialist) with a
medical or allied health science background
(non-clinical role) to support our prior authorization process. This role requires applying clinical knowledge to review, evaluate, and process medical service requests to ensure they meet payer requirements.

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, CMS, and insurance requirements.
  • Coordinate with physicians, pharmacists, and healthcare providers to obtain additional documentation.
  • Maintain accurate case records in EMR/EHR systems (Epic, Cerner, Athena).
  • Support appeals and denials management when required.

Requirements

  • Background in
    Nursing, Pharmacy, or Allied Health Sciences
    (RN, LPN, BSN, PharmD, CPhT, or equivalent).
  • Knowledge of
    ICD-10, CPT, and HCPCS coding systems
    .
  • Strong understanding of medical terminology and payer guidelines.
  • Prior experience in
    utilization management or authorization processes
    is highly preferred.
  • Excellent communication and detail-oriented problem-solving skills.

Qualifications

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

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