Key Responsibilities

- Review clinical documentation to verify medical necessity and alignment with payer medical policy guidelines
- Prioritize authorization requests based on urgency, service type, and turnaround time requirements
- Obtain prior authorizations through payer portals or telephonic follow-ups and track pending cases
- Maintain up-to-date payer-specific authorization requirements and documentation checklists
- Initiate and manage appeals for denied or partially approved authorizations
- Respond to clinic and internal team inquiries related to payer policies and authorization status
- Verify accuracy of CPT and ICD-10 codes associated with ordered procedures
- Manage high-volume, time-sensitive workloads while maintaining accuracy and compliance

Qualifications
- 2-4 years of experience in pre-authorization for the U.S. healthcare provider market
- Strong understanding of authorization workflows, denial management, and reimbursement policies




- Prior experience in healthcare revenue cycle management or authorization services
- Undergraduate degree or higher, or equivalent relevant experience

Skills
- Strong attention to detail with analytical and problem-solving abilities
- Proficiency in Microsoft Office applications (Word, Excel, Outlook)
- Clear verbal and written communication skills
- Ability to work independently, prioritize tasks, and manage multiple deadlines in a fast-paced environment

Additional information
- Client-specific systems and payer workflow training will be provided
- Role requires high documentation accuracy and strict compliance adherence
- Chance to work closely with U.S. healthcare payers and clinical authorization workflows

Highlights

Type

Full-Time

Location

Pune Office

Department

Prior Authorization

Working Day

Monday To Friday

Shift

Night Shift

📌 Medical Benefits & Authorization Executive (Pune)
🏢 3Gen Consulting
📍 Pune