Authorization Specialist

Authorization Specialist

Job Summary

We are looking for an experienced Authorisation Specialist to manage the end-to-end prior authorization process for healthcare services. The ideal candidate should have hands-on experience communicating with PCP offices and insurance companies, verifying authorization requirements, obtaining necessary approvals, and following up on pending requests. Strong knowledge of US healthcare RCM processes, excellent communication skills, and the ability to handle payer/PCP calls professionally are essential.

Key Responsibilities

1. Handle outbound calls to PCP offices to request referrals, clinical information, and authorization-related documentation.
2. Contact US insurance companies/payers to verify authorization requirements and obtain prior authorizations for medical services.
3. Verify patient eligibility, benefits, referral requirements, and authorization requirements with insurance providers.
4. Submit and follow up on authorization requests through payer portals, phone, fax, or other required channels.
5. Coordinate with PCP offices, insurance companies, providers, and internal teams to resolve authorization-related issues.
6. Track pending, approved, denied, and expired authorizations and ensure timely follow-up.
7. Maintain accurate documentation of payer and PCP conversations, authorization reference numbers, approval details, and follow-up actions.
8. Identify authorization denials or missing information and coordinate with the appropriate teams for resolution.
9. Ensure all authorization activities are completed within payer and client turnaround-time requirements.
10. Maintain confidentiality of patient information and follow HIPAA and organizational compliance requirements.

Required Skills & Experience

1. 1–3+ years of experience in US Healthcare RCM, preferably in Authorization/Referral Management.
2. Mandatory experience in calling PCP offices and US insurance companies.
3. Hands-on experience with Prior Authorization, Referral Authorization, and Benefits Verification (VOB).
4. Good understanding of US healthcare insurance, payer processes, and provider-side RCM.
5. Strong verbal and written English communication skills.
6. Ability to communicate confidently and professionally with PCP offices and insurance representatives.
7. Experience working with payer portals and authorization platforms is preferred.
8. Good documentation, follow-up, and analytical skills.
9. Ability to handle high-volume calls and work effectively within deadlines.
10. Knowledge of HIPAA and patient data confidentiality is preferred.

Key Competencies

PCP Calling | Insurance Calling | Prior Authorization | Referral Management | VOB | Eligibility & Benefits | Payer Follow-up | Denial Resolution | US Healthcare RCM | Documentation | Excellent Communication

Preferred Qualification

Any Graduate with relevant experience in US Healthcare RCM/Medical Billing/Authorization processes.