Client Partner – Prior Authorization

• Initiate and follow up on prior authorization requests with insurance companies for medical procedures, diagnostic tests, surgeries, and other healthcare services.

• Review patient eligibility, benefits, and insurance coverage using payer portals or calling payers.

• Coordinate with providers, clinical staff, or scheduling teams to obtain necessary clinical documentation for submitting authorization requests.

• Submit prior authorization requests via online portals, fax, or phone, depending on payer requirements.

• Track the status of pending authorizations and ensure timely follow-up to avoid service delays.

• Document all activities and communication in the clients system (EMR/PM/RCM software).

• Verify and update patient demographics, insurance information, and authorization details accurately.

• Maintain up-to-date knowledge of payer-specific authorization guidelines and changes.

• Escalate complex cases or delays in approvals to the team lead or client contact as necessary.

• Support denial prevention by ensuring accurate and complete submissions of authorization requests.

Job Requirements

• Any degree / diploma with 1 year of experience in prior authorization or insurance verification in US healthcare RCM.

• Familiarity with major US insurance carriers (Medicare, Medicaid, Commercial plans).

• Understanding of clinical terminologies, CPT, ICD-10, and HCPCS codes.

• Experience with EMR/RCM systems such as EPIC, Cerner, Athenahealth, etc.

• Excellent verbal and written communication skills.

• Ability to work in a high-volume, deadline-driven environment.