Process Analyst - RCM Insurance

Job Description:

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.

 Qualification & Experience

• 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.