Process Analyst - RCM Insurance

Process Associate - RCM Insurance

An Insurance Pre-Authorization role involves co-ordinating with providers and insurers to get approval for medical services(Planned , Emergency), Verifying patient eligibility, reviewing medical necessity, submitting requests, following up on approvals, documenting communication, and ensuring compliance with policies to avoid care delays and manage costs. 

Key Responsibilities

• Review & Verification: Check patient demographics, insurance eligibility, benefits, and coverage for specific medical procedures or medications.
• Submission to Insurance: Prepare and submit authorization requests with complete clinical documentation (e.g., medical necessity) to insurance companies.
• Communication & Follow-Up: Act as a liaison, contacting providers for more info and following up with insurers on pending approvals.
• Documentation: Accurately log all communications, authorization numbers, and outcomes in the system, adhering to HIPAA.

Required Skills & Qualifications

• 5+ years experience working in US Healthcare Pre-authorization / Benefit check
• Strong attention to detail and organizational skills.
• Excellent communication (written and verbal) and interpersonal abilities.
• Knowledge of medical terminology and healthcare coding (e.g., CPT, ICD-10).
• Familiarity with HIPAA regulations and insurance policies.
• Proficiency with Salesforce and EHR software.
• Ability to work efficiently under pressure, meeting turnaround times.