Healthcare Pre- Auth Specialist

Position Overview

The Healthcare Pre-Auth Specialist (Production Agent L1) at Wipro LLC plays a key role within the BPS-HLS P&P sector. Responsible for clinical coverage review and prior authorization processing, this role supports healthcare providers and members by verifying authorizations, validating referrals, and managing clinical cases. The position ensures compliance with established guidelines and regulatory requirements while streamlining healthcare operations.

Key Responsibilities

• Maintain a consistent production output while meeting quality, accuracy, and compliance standards.
• Accurately document cases in the case management system with complete and verifiable information.
• Review each case to determine eligibility for prior authorization or the need for further clinical review.
• Resolve complex issues independently by utilizing medical policies, operating procedures, and knowledge databases.
• Conduct timely outbound communications with healthcare providers and members to collect authorization details.
• Coordinate with providers to arrange treatment schedules, ensuring smooth care continuity.
• Collaborate with team members and leadership to meet organizational goals and accommodate additional duties.

Required Qualifications

• High School Diploma or GED (additional credentials in healthcare administration are beneficial).
• At least one year of professional experience in an office setting, preferably within a healthcare environment.
• Proven customer service skills with experience in outbound communication with members and providers.
• Proficiency in computer operations and the Microsoft Office suite (Outlook, Word, Excel).
• Flexibility to work defined shifts (Monday–Friday, with alternative shift options available) and occasionally outside regular hours.
• Ability to troubleshoot and set up computer equipment in a secure work-from-home environment that complies with PHI and PI protection standards.

Preferred Qualifications

• Experience with back-office medical platforms, prior authorization systems, or healthcare information management systems.
• Familiarity with healthcare industry practices, including hospital operations, medical terminology, ICD-10/CPT coding, Medicare, and Medicaid services.
• Background in clerical or administrative support roles within healthcare environments.
• Demonstrated ability to quickly learn and adapt to new computer systems or specialized software applications.

Benefits & Perks

• Compensation: $25,000 to $50,000 (final compensation depends on location, experience, and other factors).
• Benefits: Eligible for a full range of medical and dental benefits, disability insurance, paid time off (inclusive of sick leave), and additional leave options.