Referral Authorization Specialist

Job Title:Referral & Authorization Specialist (Non-Voice)

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Position Summary-

Key Responsibilities

• Referral and Authorization Processing:

  Receive, review, and process patient referrals and authorization requests from healthcare providers and facilities via fax, email, or EMR/CRM systems.

• Insurance Verification:

  Verify patient insurance eligibility, benefits, and coverage with primary and secondary insurance payers.

• Prior Authorization Acquisition:

  Obtain necessary prior authorizations/Letter of Agreements (LOAs) for requested medical services, treatments, or specialist visits as required by insurance plans.

• Documentation and Data Entry:

  Accurately enter and update all patient, insurance, and authorization information into the internal tracking and billing systems, ensuring all documentation is complete and compliant with HIPAA regulations.

• Query Resolution (Non-Voice):

  Act as a liaison between the billing team, providers, and insurance companies, responding to inquiries and clarifying information via email or internal communication channels.

• Status Tracking and Follow-up:

  Monitor the status of pending authorizations, proactively following up with insurance companies and referring physicians to prevent delays in patient care and resolve potential issues.

• Compliance and Quality Assurance:

  Ensure strict adherence to company Standard Operating Procedures (SOPs) and industry regulations, particularly HIPAA compliance regarding patient data security.

• Reporting:

  Assist the RCM team with documentation and data to ensure accurate claims submission and resolution of billing issues related to eligibility or authorization denials.

Required Qualifications and Skills

• Experience:

  Minimum 2+ years of relevant experience in a non-voice or semi-voice process within the US Healthcare domain (Medical Billing, RCM, Authorization, or Eligibility Verification is mandatory).

• Education:

  Bachelor's degree or equivalent qualification.

• Domain Knowledge:

• Mandatory knowledge of HIPAA compliance.
• Strong understanding of medical terminology, CPT/ICD-10 codes, and the prior authorization process.

• Skills:

• Exceptional written communication skills (English) with strong attention to detail and grammatical accuracy.
• Proficiency in using CRM software, Electronic Health Record (EHR) systems, and MS Office.
• Strong analytical and problem-solving abilities to identify and resolve authorization issues.
• Efficient time management and organizational skills to prioritize high volumes of tasks.

• Work Arrangement:

• Mandatory Work From Office (WFO) in Bangalore.
• Ability to work in US Shifts (Night Shifts) to align with US business hours.
• Cab facility is available