Karthik Balu

Detail-oriented Prior Authorization Representative with 4 Years of experience in processing and managing Eligibility, Benefits and Prior authorization, ER, Observation and Inpatient Notifications.

Process Associate - AGS HEALTH PVT LTD - Tirupathi

(2022-07)

Authorization specialist

• Insurance Verification: Verifying active patient coverages (Medicare, Medicaid, Managed care & Commercial plans) and gathering benefits details (copays, coinsurance, deductibles, and out-of-pocket maximums) via web portals and phone calls.
• Prior Authorizations & Referrals: Processing prior authorizations and referral requests for procedures related to radiology, cardiology, nuclear medicine, gastroenterology, urology, and ophthalmology via phone calls and fax.
• Portal Management: Submitting prior authorizations using major provider portals including Availity, Carelon, eviCore, Cohere, UHC, and UMR, Evolent
• Clinicals: Gathering and reviewing necessary medical records like Office visits, Tele medicine, Emergency visits, MRI, CT, X-RAYS, Lab reports to support authorization approvals
• Denial & Pending Management: Follow up on pending and denied authorization requests and sending additional ,Missing documents if required to secure approvals within required turnaround times (TAT).
• Provider Collaboration: Contracting with healthcare providers to collect necessary clinical documentation for timely authorization decisions.
• Record Keeping: Maintaining accurate records of all requests and Documenting them in the billing systems
• Compliance: strictly adhering to HIPAA & client guidelines and payor policies

PG - MBA FINANCE & HR - RCR Business school (2023)

UG - B.COM Computers - SDHR Degree College (2021)

INTERMEDIATE - MEC - Emeralds Junior College (2018)

SSC - Sri Vidyanikethan em High School (2016)