Ravi Lalam

Highly motivated Senior Prior Authorization Specialist with 3 years of US healthcare experience in eligibility verification, prior authorization, denial management, and appeals. Experienced in supporting Cardiology and Radiology departments for inpatient and outpatient services, Strong knowledge of US insurance payers, authorization portals, and EMR systems, with strict adherence to HIPAA compliance.

Senior Prior Authorization Specialist - MedRCM India Private Limited

(2024-12)

Client: NJ Health Care

• Verified patient insurance eligibility and benefits based on patient plan coverage.
• Initiated and submitted prior authorization requests as per procedure and payer requirements.
• Handled inpatient and outpatient authorizations for Cardiology and Radiology services.
• Processed outpatient office visits and outpatient facility.
• Reviewed clinical documentation, physician orders, and medical records to ensure medical necessity.
• Verified CPT, ICD-10, and HCPCS codes prior to authorization submission.
• Creating Referrals from Primary Care Provider to Specialist Care Provider
• Submitted and tracked authorizations using payer portals including UHC, Availity, Cigna, Carelon, Oscar, RadMD, Cohere, and eviCore.
• Followed up on pending authorization cases to meet payer turnaround times.
• Documented authorization reference numbers, approval dates, and payer responses in e Clinical Works (eCW).
• Identified authorization denials and submitted appeals with required clinical documentation.
• Ensured compliance with HIPAA guidelines and payer policies.

Prior Authorization Specialist - Omega Healthcare

(2023-02 - 2024-09)

Client: NYU Langone Hospital

• Verified insurance eligibility, benefits, and authorization requirements for radiology services.
• Reviewed patient medical records and clinical documentation to support authorization requests.
• Submitted and monitored prior authorization requests to ensure approvals prior to services.
• Used Epic EMR to document authorization status and updates.
• Worked with payer portals such as Availity, Carelon, United Healthcare, and Cigna.
• Followed up with insurance companies on pending and delayed authorizations.
• Reviewed denial reasons and prepared documentation for appeal submissions.
• Maintained detailed records of payer communications and authorization outcomes.
• Coordinated with providers and insurance companies to ensure timely approvals.

Bachelor of Technology - Acharya Nagarjuna University, India