Executive - Patient Care Coordinator

Job Summary

The Medication Prior Authorization, DME, and Medical Records Processor/Indexer supports healthcare operations by managing prior authorization requests, durable medical equipment (DME) processing, and accurate indexing and handling of medical records. The role ensures compliance, data accuracy, and timely processing to support patient care and reimbursement.

US Healthcare Prior Authorization, DME & Medical Records Processor / Indexer

Roles & Responsibilities

• Process Medication Prior Authorization (PA) requests by reviewing clinical documentation, insurance requirements, and payer guidelines.
• Coordinate with providers, pharmacies, and insurance payers to obtain approvals, clarifications, or additional documentation.
• Handle Durable Medical Equipment (DME) requests, including intake, validation, documentation review, and submission.
• Index medical records accurately by categorizing documents based on document type, date of service, and clinical relevance.
• Ensure completeness and correctness of medical records used for PA, DME, audits, or billing purposes.
• Review medical documentation for compliance with payer-specific and regulatory requirements.
• Maintain accurate tracking of authorization status, approvals, denials, and follow-ups.
• Meet defined TAT and SLA benchmarks for PA, DME, and indexing processes.
• Follow HIPAA and organizational data privacy policies while handling protected health information (PHI).
• Identify and escalate discrepancies, missing documentation, or complex cases to supervisors or quality teams.
• Support continuous improvement initiatives by adhering to quality standards and participating in audits or training.

Required Skills & Qualifications

• Understanding of US healthcare workflows, insurance processes, and payer guidelines.
• Experience in Prior Authorization, DME processing, or Medical Records Indexing.
• Familiarity with medical terminology and clinical documentation.
• Strong organizational and analytical skills.
• High accuracy, attention to detail, and ability to multitask.
• Effective written and verbal communication skills.

International calling experience is must.