
Medical Insurance Authorization
6 days ago
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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