Key Responsibilities (Job Description)
Insurance Eligibility & Advantages Verification (EBV):
Check active patient coverage, effective policy dates, and perk 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.
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 Mumbai City
🏢 Aarti N
📍 Mumbai