Medical Insurance Authorization

2 weeks ago

Lahore, Punjab, Pakistan Ali Enterprise Full time 1,440,000 - 1,800,000 per year

The Medical Insurance Authorization Department is responsible for ensuring that all medical services requiring pre-approval are authorized by insurance providers before being rendered. This role plays a critical part in streamlining patient care by verifying coverage, securing approvals, and managing communication between providers, patients, and insurance companies.

Key Responsibilities:

  • Insurance Verification:
  • Confirm active insurance status and coverage for services.
  • Determine in-network eligibility with insurance carriers.
  • Prior Authorizations:
  • Submit pre-authorization requests for procedures, tests, medications, and specialist referrals.
  • Provide medical records and clinical justifications as required.
  • Coordination & Communication:
  • Liaise with healthcare providers to gather necessary documentation.
  • Communicate with insurance representatives to track authorization status.
  • Keep patients informed about approval progress and delays.
  • Tracking & Follow-Up:
  • Monitor timelines for approvals to prevent delays in patient care.
  • Follow up on denials, request additional info when needed.
  • Appeals Handling:
  • Assist in preparing and submitting appeals for denied authorizations.
  • Support patients with alternative options if appeals are unsuccessful.
  • Documentation:
  • Maintain accurate records of authorizations, denials, communications, and insurance responses.

Qualifications:

  • High school diploma or equivalent (Bachelor's preferred)
  • Knowledge of medical terminology, insurance plans, and pre-authorization processes
  • Experience in a healthcare or insurance environment is a plus
  • Strong communication and organizational skills
  • Familiarity with EMR/EHR and insurance portals

Job Type: Full-time

Pay: Rs120, Rs150,000.00 per month

Work Location: In person

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