Senior Medical Billing & Prior Authorization Specialist ( 4+ years of expereince )

We are seeking a Senior Medical Billing & Prior Authorization Specialist with over four years of hands-on experience in US medical billing and prior authorization submissions. The ideal candidate will possess a deep understanding of insurance processes and demonstrate the ability to lead and train a growing medical billing team. This full-time position is based in DHA Phase 1, with working hours from 8 PM to 5 AM. The role involves managing end-to-end billing operations, ensuring timely and accurate prior authorization requests, and maintaining compliance with payer requirements.

Key Responsibilities

- Manage the complete US medical billing and insurance process efficiently.
- Prepare and submit prior authorization (PA) requests accurately and within deadlines.
- Follow up on pending, approved, or denied authorization requests to ensure timely resolution.
- Verify patient insurance eligibility and benefits through phone calls and payer portals.
- Confirm details such as deductibles, co-pays, co-insurance, and out-of-pocket expenses.
- Communicate professionally with insurance companies to obtain coverage and benefit information.
- Review patient insurance data to identify coverage requirements and potential issues.
- Maintain precise records of authorizations, benefits verification, and billing activities.
- Identify and promptly resolve billing or authorization discrepancies.
- Coordinate with healthcare providers and internal teams to clarify insurance requirements.
- Monitor claims status and follow up with payers as necessary.
- Ensure adherence to payer policies and internal procedures to maintain compliance.

Team Leadership & Training

- Take ownership of the medical billing and prior authorization processes.
- Train and mentor new team members as the department expands.
- Develop and update standard operating procedures and training materials.
- Provide support to team members handling complex billing, authorization, and insurance issues.
- Assist in establishing efficient workflows and maintaining quality standards.
- Gradually assume responsibility for supervising daily team activities.

Required Qualifications

- Minimum of 4 years’ experience in US medical billing.
- Strong expertise in prior authorization submissions and follow-ups.
- Proven ability in insurance benefits verification.
- Solid understanding of deductibles, co-pays, co-insurance, and out-of-pocket expenses.
- Excellent communication skills with the ability to interact professionally with insurance representatives.
- In-depth knowledge of US healthcare insurance processes.
- Experience working with medical billing software, payer portals, and electronic medical record (EMR) systems.
- High attention to detail and strong organizational skills.
- Ability to work independently and manage multiple tasks effectively.
- Previous experience in team leadership or training is highly desirable.

This role offers the opportunity to contribute significantly to the efficiency and growth of the medical billing department while developing leadership skills in a dynamic healthcare environment.