Pre Authorization Associate

As a Prior Authorization Specialist at Resolv, you will play a crucial role in managing prior authorizations and referrals to ensure timely approvals and accurate verification of insurance eligibility. Your responsibilities will include reviewing clinical data, coordinating with insurance providers, and maintaining compliance with client workflows. Operating in a fast-paced, team-oriented environment, you will need to demonstrate exceptional accuracy, critical thinking, and multitasking abilities. Working remotely, you will be part of a night shift team based in Mumbai. Your primary functions will involve verifying patient insurance coverage, initiating new prior authorizations/referrals, and reviewing clinical data against specified medical criteria. You will also monitor client schedules, follow up on pending requests, and communicate with insurance providers on a daily basis. Additionally, you will be expected to meet departmental production standards, identify and escalate issues when necessary, and support colleagues by sharing best practices and assisting in training new staff members. To qualify for this position, you should hold a Bachelor's degree in any stream and have at least 6 months to 1 year of relevant experience in Pre-authorization, Verification, or Accounts Receivable (AR). Strong attention to detail, proficiency in multitasking, and effective communication skills are essential. Knowledge of CPT Codes, ICD-10, clinical documentation requirements, and awareness of retro-authorization timelines are also required. Preferred skills that would make you stand out include prior authorization experience in Drugs and Radiology, familiarity with revenue cycle processes, and prior experience in Accounts Receivable. The ability to work independently while collaborating effectively in a team setting is highly valued. As a problem-solver, you will be adept at identifying and resolving healthcare billing discrepancies. Your organizational skills will help you manage high volumes of medical remittances efficiently, while your analytical abilities will enable you to understand healthcare financial data and denial patterns. In addition to a competitive salary, joining Resolv offers you a range of benefits including annual public holidays, 30 days of leave per calendar year, a Mediclaim policy, a Lifestyle Rewards Program, Group Term Life Insurance, Gratuity, and more.,