Key Responsibilities (Job Description)

- Insurance Eligibility & Benefits Verification (EBV):
- Check active patient coverage, effective policy dates, and benefit structures using web portals, IVR systems, or direct phone calls to insurance companies.
- Identify specific benefit limits, patient responsibilities (copays, deductibles, co-insurance), and secondary/tertiary insurance rules.
- Prior Authorization Processing (PAP):
- Determine if upcoming medical procedures, surgeries, or therapies require prior authorization.
- Submit auth requests via insurance web portals or fax, providing necessary medical documentation and clinical notes.
- Track pending authorizations to ensure they are approved before the patient's scheduled appointment date.
- Documentation & Coordination:
- Accurately document all insurance details, maximum out-of-pocket limits, and authorized tracking numbers directly into the EHR/EMR or RCM billing software.
- Collaborate with doctors, clinical staff,



and front-desk coordinators if additional clinical narratives are needed for approval.

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- Required Qualifications & Skills
- Experience: Generally requires 1 to 3+ years of experience in US Healthcare RCM, specifically handling front-end workflows.
- Knowledge Base: Solid understanding of medical billing terminology, CPT (procedure) and ICD-10 (diagnosis) codes, and different insurance plans (Medicare, Medicaid, Commercial PPOs/HMOs).
- Communication: Excellent verbal and written English communication skills for calling US insurance providers and interpreting technical policy jargon.
- Software Competency: Familiarity with clearinghouses, insurance web portals (e.g., Availity, Optum), and billing platforms.

Pay: ₹23,000.00 - ₹30,475.46 per month

Work Location: In person

📌 US Medical billing Insurance Executive (India)
🏢 Aarti N
📍 India