Qualification: Any Graduate (as per client requirement)
Salary: Best in the industry / Based on experience
Job Description
We are looking for experienced Pre-Authorization / Prior Authorization Executives to handle authorization requests for US healthcare providers, hospitals and physician practices.
The candidate will be responsible for verifying insurance eligibility, checking authorization requirements, submitting prior authorization requests to insurance companies, and following up on approval status to ensure timely patient care.
Key Responsibilities
- Verify patient insurance eligibility and benefits.
- Check whether medical procedures, services and medications require prior authorization.
- Submit prior authorization requests to US insurance companies.
- Coordinate with insurance providers, hospitals, physician offices and internal teams.
- Follow up on pending authorization requests.
- Track approval, denial and pending authorization status.
- Review clinical documentation and ensure all required information is submitted.
- Handle authorization portals of insurance companies and payer websites.
- Maintain accurate records and update authorization status in the system.
- Escalate delayed or denied authorization requests to the appropriate team.
- Meet daily productivity, quality and turnaround-time targets.
Required Skills
- Experience in US Healthcare Prior Authorization / Pre-Authorization.
- Knowledge of US healthcare insurance processes.
- Understanding of CPT, ICD-10 and medical terminology.
- Knowledge of insurance eligibility and benefits verification.
- Experience working with payer portals and authorization systems.
- Positive communication and coordination skills.
- Ability to work in night shifts.
- Good typing, analytical and problem-solving skills.