Job Title: Senior EV & Prior Authorization Associate | US Healthcare RCM

Company: Greenhive Billing Solutions

Location: Remote / Pan India

Work Mode: Remote

Shift Timing: Night Shift / US Healthcare Shift

Employment Type: Full-Time, Permanent

Experience: Minimum 5+ Years

Industry: US Healthcare / Medical Billing / Revenue Cycle Management

Job Summary:

Greenhive Billing Solutions is hiring a Senior Eligibility Verification (EV) & Prior Authorization Associate with 5+ years of experience in US Healthcare Revenue Cycle Management.

The ideal candidate should have solid hands-on experience in insurance eligibility verification, benefits verification, prior authorization, referral coordination, payer portal usage, documentation review, and communication with US insurance companies.

This role requires strong knowledge of US healthcare payer rules, patient benefits, authorization requirements, medical necessity, and front-end RCM workflows. The candidate should be able to work independently, identify coverage or authorization issues before services are rendered, and help reduce denials related to eligibility, authorization, referrals, and benefit errors.

Key Responsibilities:

Eligibility Verification / Insurance Verification:

- Verify patient insurance eligibility and active coverage for US healthcare services
- Check benefits, co-pay, deductible, coinsurance, out-of-pocket limits, plan type, and coverage limitations
- Verify primary, secondary, and tertiary insurance information when applicable
- Identify coordination of benefits (COB), inactive coverage, incorrect insurance, and payer mismatch issues
- Update insurance details accurately in billing / EMR / EHR systems
- Use payer portals, clearinghouse tools, and insurance calls to confirm eligibility and benefits
- Document verification details clearly and accurately in the system

Prior Authorization:

- Determine whether prior authorization is required based on payer, plan, CPT code, diagnosis, provider, and place of service
- Submit prior authorization requests through payer portals, fax, phone, or online tools
- Track authorization status and follow up with payers until approval, denial, or determination
- Review authorization requirements, medical necessity criteria, and required documentation
- Coordinate with providers, clinical teams, front desk,



and billing teams to collect missing information
- Maintain authorization numbers, effective dates, expiration dates, visit limits, approved CPT codes, and payer notes
- Identify and escalate urgent, denied, pending, or delayed authorization cases

Referral & Benefits Coordination:

- Review referral requirements for HMO, managed care, and payer-specific plans
- Coordinate referral status and document details accurately
- Ensure required referrals or authorizations are completed before claim submission
- Help prevent front-end denials related to missing authorization, referral, eligibility, or benefit issues

RCM Coordination & Denial Prevention:

- Work closely with charge entry, billing, AR, coding, and payment posting teams
- Identify root causes for eligibility and authorization-related denials
- Support denial prevention by improving verification accuracy and authorization tracking
- Escalate recurring payer issues, missing information, or process gaps to leadership
- Maintain accuracy, productivity, and turnaround time targets

Documentation & Reporting:

- Maintain accurate notes, trackers, and authorization logs
- Track pending authorizations and follow-up timelines
- Prepare daily / weekly status updates for pending EV and prior authorization work
- Maintain HIPAA compliance and confidentiality of patient information
- Support quality checks, audit readiness, and process improvement

Required Skills & Qualifications:

- Minimum 5+ years of experience in US Healthcare Eligibility Verification / Prior Authorization / RCM
- Strong experience in insurance verification, benefits verification, and prior authorization
- Strong understanding of US healthcare insurance plans, payer guidelines, and claim lifecycle
- Knowledge of co-pay, deductible, coinsurance, out-of-pocket, COB, HMO, PPO, Medicare, Medicaid, and commercial payer plans
- Experience submitting and tracking prior authorizations through payer portals, calls, fax,



and online tools
- Ability to identify authorization requirements based on CPT, diagnosis, payer, plan, and service type
- Experience working with payer portals and clearinghouse eligibility tools
- Strong English communication skills, both written and verbal
- Strong documentation accuracy and attention to detail
- Good computer skills and MS Office / Excel knowledge
- Ability to work independently and handle complex EV / prior authorization cases
- Comfortable working Night Shift / US Healthcare Shift

Preferred Skills:

- Experience in specialties such as Cardiology, Primary Care, Behavioral Health, Optometry, Physical Therapy, Pain Management, Radiology, Surgery, or Multi-specialty practices
- Experience with Medicare, Medicaid, BCBS, UnitedHealthcare, Aetna, Cigna, Humana, and commercial payers
- Experience with EMR / EHR / Practice Management systems such as eClinicalWorks, Athena, AdvancedMD, Kareo, NextGen, Epic, PracticeSuite, Office Ally, or similar systems
- Experience handling high-volume EV and authorization queues
- Experience working in a medical billing company, RCM company, healthcare BPO/KPO, or provider billing office

Key Competencies:

- Strong ownership mindset
- Excellent follow-up discipline
- High attention to detail
- Strong payer communication skills
- Ability to identify front-end denial risks
- Ability to work under deadlines
- Process-driven approach
- Strong documentation habits
- Problem-solving ability
- Team coordination skills

Why Join Greenhive Billing Solutions?

- Opportunity to work with a growing US healthcare RCM company
- Exposure to multiple specialties and payer workflows
- Secure long-term role
- Growth opportunity in EV, prior authorization, RCM quality, and operations
- Professional and supportive work environment

How to Apply: Apply via Naukri.com only.

Key Skills:

Eligibility Verification, Insurance Verification, Prior Authorization, Pre Authorization, Advantages Verification, US Healthcare, RCM, Revenue Cycle Management, Medical Billing, Referral Authorization, Payer Portals, Insurance Follow-up, Medicare, Medicaid, Commercial Payers, COB, Deductible, Coinsurance, Copay, HMO, PPO, Authorization Tracking, Denial Prevention, EMR, EHR, MS Excel, HIPAAWork Mode: Remote

📌 Senior EV & Prior Authorization Associate | US Healthcare RCM (Indore)
🏢 Greenhive Billing Solutions
📍 Indore