MKS Health is looking for experienced professionals in US Healthcare Eligibility, Benefits Verification, and Prior Authorization.

The candidate will be responsible for verifying patient insurance coverage, benefits, and authorization requirements and coordinating with US insurance payers to ensure accurate and timely verification.

Key Responsibilities

- Verify patient eligibility and insurance coverage.
- Verify insurance benefits, copay, deductible, coinsurance, out-of-pocket amounts, visit limits, and coverage limitations.
- Verify in-network and out-of-network benefits and provider network status.
- Determine whether services require Prior Authorization, Precertification, Referral, or Pre-Authorization.
- Initiate and process Prior Authorization requests with insurance companies.
- Follow up with insurance companies and payer portals regarding pending authorization requests.
- Track authorization numbers, approved visits/units, effective dates, and expiration dates.
- Review payer websites and portals to obtain accurate eligibility and benefit information.
- Contact US insurance representatives to clarify coverage, benefits, and authorization requirements.
- Accurately document eligibility, benefits, and authorization information in the appropriate system.
- Maintain detailed notes including reference numbers, representative names, call dates, and authorization details.
- Identify benefit restrictions, exclusions, and authorization requirements.
- Escalate discrepancies or complex insurance issues to the appropriate team.
- Complete eligibility, benefits, and authorization verification within the required turnaround time.
- Meet assigned productivity, accuracy, and quality targets.

Required Skills & Experience:





- 1 to 7 years of experience in US Healthcare Eligibility, Benefits Verification, Prior Authorization, or Medical Billing/RCM.
- Strong experience in Eligibility & Benefits Verification.
- Hands-on experience with Prior Authorization / Precertification preferred.

- Good understanding of

- Eligibility and coverage

- Deductibles

- Copays

- Coinsurance
- Out-of-pocket amounts
- In-Network / Out-of-Network benefits

- Visit limits

- Referrals

- Prior Authorization requirements
- Experience working with US insurance payers and payer portals.
- Good verbal and written communication skills.
- Solid attention to detail and documentation skills.
- Ability to communicate professionally with US insurance representatives.
- Immediate joiners preferred.

Important Company Policies:

- Work Mode: Work From Office only.
- Work Location: Uppal, Hyderabad.
- Shift Timing: 05:30 PM IST to 02:30 AM IST (US Night Shift).
- Cab / Transportation Facility: Not provided.
- PF: Not provided.
- Candidates must be comfortable with the above work location, shift timing, and company policies.

Application Process: Pre-screening is mandatory.

Candidates who are comfortable with the above requirements can complete the MKS Health Pre-Screening Form and apply for the position.

Pre-Screening Form:

https://docs.google.com/forms/d/e/1FAIpQLScqDzrcKWKxlHeg8V4IHoiuUG3gCgM1JKx1r_DULIACPLYD1w/viewform

Only candidates who complete the pre-screening form and meet the requirements will be considered for interview scheduling.

Please apply only if you are comfortable with the US night shift, Work From Office requirement, and the company policies mentioned above.

CONTACT NUMBER: +91 70327 42059 (Dileep Kumar)

📌 Urgent Hiring - US Healthcare Eligibility & Prior Authorization (Hyderabad)
🏢 Martin Knowledge Solutions
📍 Hyderabad