RCM Associate

Role Overview: As a Pre Authorization Specialist, your primary responsibility will be to obtain prior-authorizations and referrals from insurance companies before procedures or surgeries, using online platforms or phone calls. You will also be in charge of monitoring and updating current orders and tasks to ensure accurate and up-to-date information is maintained. Additionally, you will provide insurance companies with the necessary clinical information for securing prior-authorizations or referrals. A good understanding of medical terminology and progress notes will be essential in this role. Key Responsibilities: - Obtain prior-authorizations and referrals from insurance companies for injections, DME, procedures, and surgeries. - Update and maintain current orders and tasks to ensure accuracy. - Provide clinical information to insurance companies as required for prior-authorizations or referrals. - Request retro-authorizations when necessary. - Analyze accounts and take appropriate actions to achieve defined Turnaround Time (TAT) and Quality benchmark score. - Ensure resolution-oriented actions are taken while working on assigned tasks/cases. - Task claims to the relevant teams within the organization or clients for assistance when needed. Qualifications Required: - Proficient in obtaining prior-authorizations and referrals from insurance companies. - Familiarity with medical terminology and progress notes. - Strong communication skills for interacting with insurance companies and internal teams effectively. - Ability to work during the specified shift timings of 5:30 PM to 2:30 AM or 6:30 PM to 3:30 AM. (Note: The additional details section "EVBV:" was omitted as it did not provide relevant information for the job description.),