Prior authorization expert

Location: In-office, Hebbal, Bengaluru

Employment Type: Full-Time

Timings: Night Shift – U. S. Time Zone (7:30 PM–4:30 AM IST)

About Us

Lenity Health is a mission-driven healthcare organization focused on creating exceptional experiences for patients, providers, and care teams across the U. S. healthcare ecosystem.

We help physician practices and healthcare systems improve efficiency, care quality, and scalability by combining skilled healthcare professionals with intelligent technology. With teams in the United States and India, Lenity Health brings deep experience in clinical operations, value-based care, and health technology.

About the Role

The Virtual Medical Assistant – Prior Authorization will support U. S.-based physician practices by managing prior authorization, denial, appeal, and referral workflows.

This role requires someone who is detail-oriented, proactive, and comfortable navigating payer portals, EHR systems, and insurance requirements. The ideal candidate can manage a high volume of cases accurately while communicating clearly with providers, care teams, and patients.

Key Responsibilities

Submit and track prior authorization requests for medications, procedures, imaging, and durable medical equipment (DME) through payer portals such as Availity and Cover My Meds, as well as by phone or fax when required. Review clinical documentation to ensure medical necessity and payer-specific criteria are met before submitting requests. Follow up on pending, denied, and expiring authorizations to avoid delays in patient care. Review denial reasons, identify root causes, and determine the appropriate appeal pathway. Draft and submit appeal letters with relevant clinical documentation. Process and coordinate referral requests in accordance with practice and payer requirements. Communicate authorization status, documentation requirements, and delays clearly to providers, care teams, front-desk staff, and patients. Coordinate with billing, clinical, and administrative teams to obtain missing documentation or information. Maintain accurate documentation, authorization status updates, and productivity trackers. Meet daily productivity benchmarks, turnaround-time expectations, and quality standards. Participate in quality audits and incorporate feedback to improve accuracy and workflow performance. Follow all SOPs, HIPAA requirements, data-security standards, and patient confidentiality protocols. Identify urgent cases, workflow bottlenecks, and recurring denial trends, and escalate concerns appropriately. Collaborate effectively with U. S.-based providers and internal teams across time zones.

Required Qualifications

Medical sciences background required, including BDS, MBBS, BHMS, BAMS, Nursing, Life Sciences, or an equivalent degree. At least 2 years of experience in prior authorization, insurance verification, medical billing, referrals, or another payer-facing U. S. healthcare role. Strong understanding of commercial insurance, Medicare, Medicaid, plan structures, and payer requirements. Working knowledge of medical billing and coding terminology, including CPT, ICD-10, and HCPCS codes. Experience working with payer portals such as Availity and Cover My Meds. Familiarity with EHR systems such as e Clinical Works, Athenahealth, Epic, or similar platforms. Strong analytical and problem-solving skills, including the ability to interpret payer criteria and identify appeal opportunities. Excellent written and verbal English communication skills. Highly organized, detail-oriented, and comfortable managing a high volume of cases. Strong ownership, reliability, and willingness to learn and adopt new technologies.