Professional, Quality Analysis (PA)

• • Minimum of 2.5–5 years of experience in the healthcare industry, specifically in Prior Authorization.
• Proficient in CPT codes, diagnostic codes, and procedure or medication authorization across specialties such as Gastroenterology, Urology, Infusions, DME, and others.
• Solid understanding of co-pay and out-of-pocket expenses from an insurance standpoint.
• Skilled in using Microsoft Office Suite (Excel, Word, Outlook) and navigating the Internet effectively.
• Capable of handling confidential and sensitive information with discretion.
• Strong analytical skills to evaluate data and identify patterns or issues within the prior authorization workflow.
• Familiarity with medical terminology, insurance policies, and hospital billing procedures.
• High attention to detail and accuracy to ensure compliance with healthcare regulations and standards.
• Excellent verbal and written communication skills for effective interaction with healthcare providers, insurance companies, and internal teams.
• Problem-solving abilities to identify challenges and implement solutions that enhance the prior authorization process.
• Proficiency in using healthcare information systems and software related to prior authorization and claims processing.
• Collaborative mindset with the ability to work effectively in teams to streamline processes.

Department: Quality
Experience: 2.5 to 5
Posted: 2026-08-14T06:55:08.543Z