Job Description

Job Duties and Responsibilities:

Individual Contributor Functions

• Perform insurance verification and benefits investigation as directed by client
• Validate patient eligibility, coverage, and payer requirements
• Identify prior authorization requirements based on client guidelines
• Submit and track prior authorizations using client systems
• Document all activities accurately on client platforms
• Handle payer communications through portals and outbound calls
• Flag discrepancies or missing information for client review

IV and PA Process Execution and Oversight

• Perform and support insurance verification, benefits investigation, and eligibility checks
• Identify authorization requirements across multiple payers based on client guidelines
• Submit, track, and follow up on prior authorization requests
• Review complex cases, escalations, and payer-related issues, then elevate to the client as needed
• Ensure accurate documentation in client systems including EMR and DME platforms
• Validate benefit checks, test claims, and payer communications
• Ensure alignment with payer guidelines and billing requirements as defined by the client

DME and RCM Support

• Support eligibility and authorization workflows for client-specific products and services as directed
• Ensure accurate interpretation of benefits and alignment with payer requirements
• Support end-to-end RCM workflows that impact reimbursement outcomes

Cross Functional Collaboration

• Partner with QA, Training, Workforce, Operations, and client teams
• Support client requirements and program needs
• Handle escalations and ensure timely coordination with the client
• Participate in projects, audits, and business initiatives as required

Job Required Qualification:

• Minimum 3-year solid experience with US Healthcare Insurance
• At least 1 year work experience in a customer service call center (Voice and Back office)
• Strong knowledge of insurance verification and prior authorization workflows
• Familiarity with EMR, DME systems, payer portals, and database entry
• Strong understanding of HIPAA compliance and medical terminology
• Ability to manage high volume workloads and meet performance targets
• Proficiency in MS Word, Excel, and Outlook
• Experience with medical Insurance/Benefits investigation and Authorizations.
• High attention to detail and documentation accuracy
• Excellent Customer service skills, including phone and interpersonal skills.
• Typing speed of at least 35 WPM with high accuracy
• Database data entry experience preferred.
• Strong English proficiency, both written and verbal
• Strong attendance, reliability, and accountability
• Ability to work effectively with diverse teams and clients
• High comfort level working with culturally diverse team members and clients.
• Proficient mathematical skills, including addition, subtraction, multiplication, and division.

Preferred Qualifications:

• Startup / rapid growth experience
• Life sciences, pharmaceutical, or medical device experience.
• Knowledge of medical terminology preferred.
• Knowledge on diabetes or diabetes supplies