Hiring -Clinical Prior Authorization Executive & QA roles in Hyderabad

1 - 4 years

2 - 5 Lacs

Posted:3 hours ago| Platform: Naukri logo

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Job Type

Full Time

Job Description

We're Hiring! | Clinical Prior Authorization Executive & QA

Open Roles:

  1. Clinical Prior Authorization Executive

  2. Quality Analyst (QA) Prior Authorization


Job Responsibilities:

For Clinical Prior Authorization Executive:

  • Review medical records and prior authorization requests.
  • Validate clinical necessity based on payer policies and guidelines.
  • Coordinate with healthcare providers and insurance companies.
  • Accurately document and process approvals/denials in the system.

For QA Role:

  • Audit completed prior authorization cases.
  • Ensure compliance with quality standards and turnaround times (TAT).
  • Provide feedback and support to improve team performance.
  • Maintain documentation and generate quality reports.

Requirements:

  • Bachelor's degree in Life Sciences, Pharmacy, Nursing, or equivalent.
  • Dimploma are not eligible or

  • Prior experience in

    US Healthcare

    or

    RCM (Revenue Cycle Management)

    preferred.
  • Strong communication skills (written & verbal).
  • Detail-oriented with strong analytical thinking.

Interested candidates can share your updated resume to

HR Sumalika - 9030461574 (share resume via WhatsApp)

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