Prior Authorization

Job Title: Prior Authorization (Health Care)

Summary: Experienced in Prior Authorization for Employer Health Care with 3 years of hands‑on expertise as well as on Portals Like Availity, Navinet, Carefirst, UHC, Waystar, Cigan. Skilled in reviewing medical necessity, coordinating with insurance Representative, reduce turnaround times too

**Responsibilities:**
Authorization Review: Evaluate prior authorization requests for medical procedures, medications, and treatments under Patient health plans.
Documentation Verification: Ensure accuracy and completeness of clinical documentation submitted by providers.
Insurance Coordination: Work directly with insurance carriers to obtain approvals and clarify policy requirements.
Compliance Monitoring: Maintain adherence to healthcare regulations, payer guidelines, and HIPAA standards.
Process Improvement: Identify workflow bottlenecks and implement solutions to reduce turnaround times.
Record Maintenance: Keep detailed logs of authorization requests, approvals, and denials for audit readiness.
Qualifications:
- Bachelor’s degree in Finance
- 3 years of experience in Healthcare
- Strong communication and analytical skills

Culture & Benefits:
Opportunities to expand knowledge of payer policies, compliance standards, and healthcare regulations. A workplace that values teamwork, communication, and shared responsibility. Health coverage, flexible scheduling, and training programs to enhance skills