Point OF Contact for Interview Scheduling :-

Pavan Kalyan - (phone hidden)

Jeshima - (phone hidden)

Role : Prior Authorization/ Pre Auth

Location : Coimbatore -Saravanampatti

Role & responsibilities

- Initiate and submit prior authorization requests to US insurance companies via web portals, phone, or fax.
- Collect and verify all necessary clinical documentation, demographics, and insurance information from providers.
- Follow up regularly with insurance companies to track status and secure timely approvals.
- Update patient accounts and internal workflow systems with accurate authorization details, approval numbers, and valid dates.
- Meet daily and weekly targets for volume, accuracy, and turnaround time.
- Handle complex prior authorization cases, retro-authorizations, and urgent expedited requests.
- Review and analyze insurance denials related to prior authorization; prepare and submit formal appeals with required medical necessity documentation.
- Act as a Subject Matter Expert (SME) to guide junior team members and resolve process bottlenecks.
- Maintain direct communication with clinic coordinators, physicians,



or insurance medical directors to resolve disputes.
- Monitor key performance metrics and report daily productivity and denial trends to management.

Preferred candidate profile

- Experience: 1 to 4 years of core experience in US Healthcare Prior Authorization or Pre-Certification.
- Education: Any Graduate (B.Com, B.Sc, BBA, BA) / Post Graduate. B.Pharm, M.Pharm, or Life Science graduates are highly preferred.
- Insurance Knowledge: Strong understanding of US major insurance payers (Aetna, Blue Cross Blue Shield, Cigna, Humana, UnitedHealthcare, Medicare, Medicaid).
- Medical Terminology: Sound knowledge of ICD-10, CPT, and HCPCS codes related to authorizations.
- Software Skills: Experience working with RCM software or EHR systems like Epic, eClinicalWorks (eCW), Allscripts, or clearinghouses like Availity and Navinet.
- Communication: Excellent spoken and written English communication skills, with qualified telephone etiquette for calling US insurance reps.

📌 Walk-in || Senior Executive / Executive - Prior Authorization (Coimbatore)
🏢 IKS Health
📍 Coimbatore