QA & Authorization Coordinator

About the Role:
We are currently seeking a skilled and detail-oriented QA & Authorization Coordinator to join our dynamic healthcare team. The ideal candidate will have a clinical background and prior experience in handling medical authorizations. This dual-role position will be critical in ensuring high standards of quality assurance while efficiently managing authorization processes.

Key Responsibilities:

Responsibilities:

• Insurance Verification & Prior Authorization:
• Verify patient eligibility, coverage, and benefits for requested medical services.
• Obtain prior authorization for procedures, diagnostic tests, medications, and treatments from insurance providers.
• Communicate authorization status and requirements to physicians, patients, and medical staff.
• Claims & Denial Management:
• Track and follow up on pending authorizations to prevent delays in patient care.

✅ Technology & Systems:

• Utilize EMR/EHR systems (e.g., Epic, Cerner, Athenahealth) and payer portals for authorization submissions.
• Maintain detailed records of authorization requests, approvals, and denials.
• Handle authorization denials, appeals, and reconsiderations efficiently.
• Coordinate with billing and coding teams to resolve claim-related issues.
• Review, process, and follow up on prior authorizations for medical services.
• Coordinate with insurance providers, physicians, and internal teams to obtain necessary approvals.
• Perform quality checks on documentation and workflows to ensure accuracy and compliance.
• Maintain detailed records of authorization requests, responses, and outcomes.
• Assist in developing and improving QA protocols related to authorization procedures.
• Provide support in audits and reporting for compliance and process improvement.

Requirements:

• A clinical degree (e.g., Nursing, Allied Health, or equivalent).
• Proven experience in medical authorization and insurance verification.
• Strong understanding of healthcare documentation and medical terminology.
• Excellent organizational and communication skills.
• Attention to detail with the ability to manage multiple tasks efficiently.
• Familiarity with electronic medical records (EMR) systems is a plus.

Why Join Us?

• Be part of a growing and supportive team committed to healthcare excellence.
• Opportunities for professional development and growth.
• Competitive salary and benefits package.

How to Apply:
Interested candidates are encouraged to submit their updated resume along with a brief cover letter to hr@pathwellhealth.com

Job Types: Full-time, Permanent

Pay: ₹30,000.00 - ₹50,000.00 per month

Benefits:

• Health insurance
• Paid sick time
• Provident Fund

Work Location: In person