Job Description

Job Description: We are seeking an experienced Insurance Authorization Specialist II who will be responsible for obtaining and managing insurance authorizations for various procedures, treatments, and services, including retro authorizations. This role involves working closely with insurance companies and providers to secure prior approvals, resolve authorization issues, and submitting appeals when retro authorizations are required in a timely manner. Specialist will use expertise and communicate with the payer and provider to reduce claim denials and ensure that provider services are reimbursed in full. Key Responsibilities: Obtain and Manage Authorizations : Secure prior authorizations for medical procedures, treatments, and services as required by insurance providers, including retroactive authorizations. Collaboration : Work with insurance companies, providers, and billing teams to ensure all required authorizations are obtained prior to services being rendered and claims being submitted. Data Management: The position requires Excel knowledge to maintain and create reports of authorization levels, track trends, and analyze data to ensure efficient and accurate reporting. Appeals Process : Support the appeals process for denied claims, particularly for cases involving retroactive authorization requests. This includes gathering the necessary documentation and submitting appeals to insurance providers. Communication: The role requires participating in calls and emails with both clients and insurance companies to set up and streamline workflows, ensuring smooth integration of authorization processes. Process Improvement : Identify opportunities to streamline authorization processes and reduce delays, contributing to more efficient claim submissions and better reimbursement outcomes. Team Support : Collaborate with team members Authorization, billing and provider relations, to ensure that all authorization processes align with organizational goals. Qualifications: Experience: Minimum of 1-2 years of experience in insurance authorization with a working knowledge of insurance procedures and authorization processes. Knowledge : In-depth understanding of insurance Authorization guidelines, authorization processes. Excel Skills : Advanced proficiency in Microsoft Excel, including the ability to create and manage spreadsheets, use pivot tables, formulas to analyze and report data. Experience in tracking authorization data and generating reports is a must. Communication Skills: Strong verbal and written communication skills are crucial for effectively coordinating with Payer, US team and provider, ensuring that authorization processes are clear, issues are promptly addressed, and workflows run smoothly. PLEASE NOTE Work from Office only (Location: -Vadodara, Gujarat) US/Night Shift