Healthcare SME - Benefits Verification and Prior Authorization

Job description:

We are seeking a Healthcare RCM Specialist with strong expertise in prior authorization and pre-clearance workflows . This role serves as a subject matter expert in insurance verification, payer requirements, and front-end revenue cycle operations, ensuring compliance, accuracy, and timely processing to reduce denials and improve patient access outcomes.

Key Responsibilities:

Process Expertise & Governance

• Act as the primary expert on pre-clearance and prior authorization workflows
• Ensure compliance with payer guidelines and healthcare regulations (e.g., HIPAA)
• Provide guidance on complex cases, escalations, and exception handling

Insurance Verification & Authorization Oversight

• Oversee insurance eligibility verification and benefits validation
• Manage prior authorization submissions and fol...