Job Description
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 benefi...