Prior Authorization Specialist

Company Description

Business Outsourcing & Staffing Solutions (BOSS) is a vibrant company established by medical professionals to offer specialized back-office services for small and medium healthcare practices in the USA. Based in Hyderabad, India, BOSS provides comprehensive support, including front office, back office, clinical back office, data management, and document management solutions. Our services are designed to streamline operations, enabling healthcare practices to focus on patient care. We pride ourselves on delivering high-quality operational support tailored to the healthcare industry.

Role

•  Conduct prior authorization requests for medical procedures, drugs, and services.
• Verify patient insurance eligibility and benefits using payer portals and phone calls.
• Identify and calculate Patient responsibilities. Such as Copay, Deductibles, and Co-Insurance.
• Communicate with insurance companies, providers, and patients to resolve authorization issues.
•  Maintain accurate documentation and follow HIPAA compliance standards.
• Collaborate with clinical and administrative teams to ensure timely approvals.

Qualifications

•  Minimum 2 years of experience in U.S. healthcare prior authorization and eligibility verification.
•  Familiarity with major insurance providers (Medicare, Medicaid, commercial payers).
• Proficiency in using EMR & EHR systems and payer portals.
•  Strong communication and organizational skills.
•  Knowledge of medical terminology and coding (CPT, ICD-10) is a plus.