Rcm Specialist

Role & rSenior Executive - Authorization

Job Description:

Responsible for end-to-end processing and follow-up of medical service authorization requests for US healthcare clients.

Key Responsibilities:

Process prior authorization and referral requests within defined TAT.

Submit authorizations through payer portals, online systems, fax, email and phone.

Verify patient, provider, insurance, CPT, diagnosis and service details before submission.

Review payer-specific authorization and referral requirements.

Ensure required clinical documentation is submitted accurately.

Track pending, approved, denied, cancelled and expired authorizations.

Follow up with payers and resolve authorization delays and denials.

Communicate authorization status and critical cases to clients.

Handle authorization tickets and participate in client calls.

Escalate complex cases requiring additional documentation, peer-to-peer or reconsideration.

Maintain accurate authorization records and work queues.

Support junior team members and assist with complex cases.

Prepare productivity, status and denial reports.

Identify process issues and contribute to workflow improvements.

Required Skills:

Strong knowledge of US healthcare insurance authorization and referral processes.

Good understanding of eligibility, benefits and payer requirements.

Knowledge of CPT, HCPCS, ICD-10 and medical terminology preferred.

Experience with payer portals and healthcare RCM systems.

Strong communication, follow-up and analytical skills.

Excellent attention to detail and ability to manage high-volume work.

Ability to work independently and meet strict TAT and quality targets.

Qualifications:

Bachelor's degree or equivalent.

4+ years of US Healthcare Medical Billing/RCM experience.

3+ years of hands-on Authorization experience preferred.

Keywords:

US Healthcare, Medical Billing, RCM, Prior Authorization, Referral, Insurance Verification, CPT, HCPCS, ICD-10, Pain Management, Workers Compensation, DrChrono, Availity, Cohere, RadMDesponsibilities

Preferred candidate profile