Authorization Representative (Night Shift)

About the role

Medcare MSO, a healthcare IT company with more than 900 employees, is hiring an Authorization Representative for its Lahore office. The role works night shifts (07:00 PM to 04:00 AM) and involves verifying patient insurance eligibility and obtaining pre-certifications and prior authorizations for inpatient hospital stays, so that planned treatments and procedures are covered and medically appropriate before admission.

Key responsibilities

• Review patient insurance information to confirm eligibility, benefits and coverage for inpatient services.
• Initiate and manage pre-certification and prior authorization requests by providing medical documentation and clinical rationale.
• Assess medical records against clinical guidelines and medical necessity criteria to judge the appropriateness of inpatient admission.
• Collaborate with physicians, nurses and case managers to gather medical information and discuss treatment plans.
• Communicate with insurance companies to resolve denials, appeals and approvals for complex cases.
• Maintain detailed records of patient interactions, authorization requests and clinical justifications in the electronic health record.
• Ensure compliance with payer regulations and state and federal healthcare guidelines.

Required profile

• Bachelor's degree in Psychiatry or BS Psychology.
• Fresh graduates or up to 1 year of experience.
• Ability to work in a hospital setting within the utilization management department, with frequent phone contact with providers and insurers.

Required skills

• Understanding of medical terminology, disease processes and treatment options.
• Familiarity with insurance plans, benefit structures and authorization requirements.
• Excellent verbal and written communication with patients, providers and insurers.
• Ability to evaluate medical information critically and resolve complex coverage and care-coordination issues.