Executive / Sr Executive / Prior Authorization ( US Healthcare)

Job description

Designation - Executive / Sr. Executive- Authorization Job Location - Noida Reports To- Team Lead / Assistant Manager Shift- Night (6:30 PM to 3:30 AM) Key Responsibilities: • Initiate and follow up on prior authorization requests with insurance companies for medical procedures, diagnostic tests, surgeries, and other healthcare services. • Review patient eligibility, benefits, and insurance coverage using payer portals or calling payers. • Coordinate with providers, clinical staff, or scheduling teams to obtain necessary clinical documentation for submitting authorization requests. • Submit prior authorization requests via online portals, fax, or phone, depending on payer requirements. • Track the status of pending authorizations and ensure timely follow-up to avoid service delays. • Document all activities and communication in the client's system (EMR/PM/RCM software). • Verify and update patient demographics, insurance information, and authorization details accurately. • Maintain up-to-date knowledge of payer-specific authorization guidelines and changes. • Escalate complex cases or delays in approvals to the team lead or client contact as necessary. • Support denial prevention by ensuring accurate and complete submissions of authorization requests. Required skill set: • Any degree / diploma with 1 year of experience in prior authorization or insurance verification in US healthcare RCM. • Familiarity with major US insurance carriers (Medicare, Medicaid, Commercial plans). • Understanding of clinical terminologies, CPT, ICD-10, and HCPCS codes. • Experience with EMR/RCM systems such as EPIC, Cerner, Athenahealth, etc. • Excellent verbal and written communication skills. • Ability to work in a high-volume, deadline-driven environment. How to Apply: Interested candidates can apply directly on Naukri or share their resume at 7303413866-HR Prerna 92056 09777 -HR Kirti 9289356699 -HR NIdhi 9650507553 -HR Divya 9910660109 - HR Sahil