Exciting Opportunities For Pre-Authorization Associate/Eligibility

Business Unit:

Job Summary:

Responsible for managing prior authorizations and referrals, including verifying insurance eligibility, reviewing clinical data, and ensuring timely approvals. Must demonstrate accuracy (95%+), critical thinking, problem-solving, and the ability to multitask in a fast-paced, team-oriented environment while maintaining compliance with client workflows.

Work Mode:

Primary Functions:

• Verify patient insurance coverage and eligibility.
• Identify and complete the correct prior authorization form required for each payer.
• Assist in the initiation of new prior authorization/referrals.
• Review clinical data against specified medical criteria for authorization.
• Review incoming orders for completeness to determine if an authorization will be approved.
• Monitor client schedules for upcoming appointments to ensure timely approvals.
• Follow up on pending requests and maintain proper tracking until closure.
• Utilize payer portals to submit and monitor authorizations.
• Coordinate Peer-to-Peer reviews when necessary.
• Communicate with insurance providers daily to obtain and confirm authorizations.
• Ensure compliance with client workflows, payer protocols, and company standards.
• Meet departmental production standards and accuracy benchmarks consistently.
• Identify issues and escalate to management when required.
• Support the team approach by assisting colleagues and sharing best practices.
• Train new staff members when assigned.
• Perform additional duties as assigned.

(Mandatory Qualifications & Skills):

Bachelors degree (in any stream).

• At least 6 months to 1 year of relevant experience in Pre-authorization, Verification, or Accounts Receivable (AR).
• Strong attention to detail with the ability to work in a fast-paced environment.
• Proficiency in multitasking and meeting accuracy standards (95%+).
• Effective written and verbal communication skills.
• Knowledge of CPT Codes and ICD-10.
• Knowledge of clinical documentation required for authorizations/referrals.
• Awareness of retro-authorization timelines.
• Understanding of differences between referrals and authorizations.

What Would Make You Stand Out:

(Preferred/Good-to-Have Skills)

Prior Authorization experience in Drugs and Radiology.

• Familiarity with revenue cycle processes.
• Accounts Receivable experience.
• Ability to work independently while collaborating effectively in a team.

Skills/ Behavioural Skills:

• Problem-Solver: Identifies and resolves healthcare billing discrepancies.
• Organized: Manages high volumes of medical remittances efficiently.
• Clear Communicator: Effectively discusses payment issues with healthcare teams.
• Analytical: Understands healthcare financial data and denial patterns.

Benefits:

• Annual Public Holidays as applicable
• 30 days total leave per calendar year
• Mediclaim policy
• Lifestyle Rewards Program
• Group Term Life Insurance
• Gratuity
• ...and more!