Insurance verification & Prior Authorization Specialist (Sahibzada Ajit Singh

Position Summary We are seeking an experienced Patient Access, Prior Authorization & Revenue Cycle Specialist to support U.S.-based medical practices. This combined position will manage the patient journey from appointment scheduling and insurance verification through claim follow-up, denial resolution, and payment collection. The ideal candidate will have experience working with U.S. healthcare providers, insurance companies, electronic medical records, and medical billing systems. The candidate must be organized, professional, detail-oriented, and comfortable communicating with patients, medical offices, insurance representatives, and billing teams. Key Responsibilities Patient Access and Scheduling - Answer incoming patient calls professionally and promptly. - Schedule, reschedule, and cancel patient appointments. - Register new patients and update demographic and insurance information. - Confirm appointments and follow up with patients regarding missing information. - Assist patients with general questions about appointments, referrals, and clinic procedures. - Document all patient communication accurately in the electronic medical record. Insurance Verification and Prior Authorization - Verify insurance eligibility, benefits, deductibles, copayments, coinsurance, and coverage limitations. - Confirm whether referrals or prior authorizations are required. - Submit prior authorization requests for office visits, diagnostic testing, procedures, surgeries, medications, and other services. - Follow up with insurance companies regarding pending authorizations. - Track authorization expiration dates, approved services, and visit limitations. - Communicate authorization requirements and outcomes to patients and clinical staff. - Maintain detailed documentation of all insurance calls, reference numbers, and authorization decisions. Medical Billing and Claims Follow-Up - Review claims for completeness and accuracy before submission. - Identify missing information, coding issues, registration errors, or authorization problems that could delay payment. - Follow up on unpaid, underpaid, rejected, and denied claims. - Review insurance explanations of benefits and remittance advice. - Correct claim errors and submit corrected or reconsidered claims. - Prepare and submit insurance appeals with appropriate supporting documentation. - Contact insurance companies to determine claim status and resolve payment delays. Accounts Receivable and Denial Management - Work insurance accounts receivable reports according to timely-filing requirements. - Investigate denials related to eligibility, authorization, referrals, coding, medical necessity, duplicate claims, and missing information. - Identify recurring denial trends and recommend corrective measures. - Escalate complex billing or payer issues to management. - Document every follow-up action clearly in the billing system. - Help reduce outstanding accounts receivable and improve overall collections. Payment and Patient Account Support - Post insurance and patient payments when assigned. - Review payment discrepancies and contractual adjustments. - Assist patients with questions regarding balances, statements, copayments, and insurance processing. - Coordinate with the U.S. practice regarding payment plans, refunds, and unresolved patient balances. - Maintain professionalism and confidentiality when discussing financial information. Required Qualifications - Minimum of 2 years of experience in U.S. healthcare administration, insurance verification, prior authorization, medical billing, accounts receivable, or denial management. - Solid understanding of U.S. commercial insurance, Medicare, Medicaid, managed-care plans, and workers compensation or personal-injury billing is preferred. - Experience working with electronic medical records and medical billing software. - Knowledge of HIPAA requirements and patient confidentiality. - Excellent spoken and written English. - Strong telephone communication and customer-service skills. - Ability to communicate professionally with U.S. patients and insurance representatives. - Strong attention to detail, follow-through, and documentation skills. - Ability to manage several responsibilities and prioritize time-sensitive work. - Willingness to work hours aligned with U.S. medical-practice operations. Preferred Qualifications - Experience supporting primary care, plastic surgery, hand surgery, behavioral health, weight-management, or multispecialty practices. - Familiarity with medical terminology, CPT codes, ICD-10 codes, claim forms, payer portals, and denial categories. - Experience with eMed or a comparable U.S. electronic medical record system. - Previous experience in a healthcare BPO, medical call center, physician office, or revenue-cycle company. - Training or certification in medical billing, coding, or healthcare administration is an advantage. Performance Expectations The employee will be evaluated based .