Prior Authorization (Voice Process) Professional

Job highlights

• 1-4 years of experience in Prior Authorization,Pre-Certification,or Utilization Management (US Healthcare). Strong understanding of US insurance payers,CPTICD codes,medical necessity guidelines,and RCM workflows. Good communication skills.

• Experience with payer portals such as Availity,Optum,Aetna,etc. Ability to multitask,prioritize,and meet turnaround deadlines.

• Review clinical documents, determine authorization requirements, and submit prior authorization requests to insurance payers.

• Follow up with payers to ensure timely approvals and maintain accurate authorization records.

• Coordinate with providers to obtain required clinical information and ensure compliance with payer guidelines.

• Communicate authorization status to internal teams and support ARRCM teams to reduce authorization-related denials.

• Resolve payer issues, assist with appeals, and ensure compliance with HIPAA and organizational standards.

Skill Sets

• 1-4 years of experience in Prior Authorization , Pre-Certification, or Utilization Management (US Healthcare).
• Strong understanding of US insurance payers , CPTICD codes, medical necessity guidelines, and RCM workflows.
• Good communication skills.
• Experience with payer portals such as Availity, Optum, Aetna, etc.
• Ability to multitask, prioritize, and meet turnaround deadlines.
• Familiarity with EHR Practice Management systems is a plus.