Pre-Service RCM Specialist (Prior Authorization / Insurance Verification)
Core
Verify insurance benefits, secure prior authorizations, and manage clinical records for high-value surgical cases to ensure accurate payment.
Role type
Pre-Service Revenue Cycle Specialist (Prior Authorization & Insurance Verification)
Builds
Clean claims and authorized surgical procedures for U.S. surgical practices
Domain
U.S. Healthcare Revenue Cycle / Surgical Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Prior authorization management, Insurance verification (VOB), Clinical record retrieval, Payer policy analysis, Authorization appeals, Payer portal navigation, Phone communication, Meticulous documentation
Preferred skills
Surgical specialty experience, Medical terminology knowledge, U.S.-facing revenue cycle company experience
Technologies
Availity, Major carrier portals
Responsibilities
Run verification of benefits (VOB) and eligibility checks for surgical cases, Handle carrier phone work for authorization status and expedites, Follow up on clinical records with surgeon offices, Prepare and submit prior authorizations via portal or fax, Review payer medical necessity criteria against clinical records, Write and follow through on authorization appeals
Seniority
Mid-level, hands-on IC