Executive / Sr Executive / Prior Authorization ( US Healthcare)

Access Healthcare; Dadri; On-site; INR 400,000 - 600,000; Full time

Job summary

Access Healthcare is seeking an Executive/Senior Executive- Authorization for night shift at Noida. You will initiate and follow up on prior authorizations, verify patient eligibility, and coordinate with providers to collect required documentation.

The role requires familiarity with US payers, CPT/ICD-10/HCPCS coding, and EMR/RCM systems, with strong communication for high-volume environments.

Qualifications

• Prior authorization or insurance verification experience in US healthcare.
• Familiar with Medicare, Medicaid, and commercial plans.
• Knowledge of CPT, ICD-10 and HCPCS coding.
• Experience with EMR/RCM systems like EPIC, Cerner, Athenahealth.
• Excellent verbal and written communication skills.
• Ability to work in a high-volume, deadline-driven environment.

Responsibilities

• Initiate and follow up on prior authorization requests with insurance companies.
• Review patient eligibility, benefits and coverage using payer portals or calls.
• Coordinate with providers and clinical staff to obtain necessary documentation.
• Submit prior authorization requests via online portals, fax, or phone.
• Track status of authorizations and ensure timely follow-up to avoid delays.
• Document all activities in the client’s system (EMR/RCM).

Skills

Prior authorization

Insurance verification

US healthcare RCM

Medicare/Medicaid

CPT/ICD-10/HCPCS

EMR/RCM systems

Communication skills

Fast-paced environment

Education

Any degree / diploma

Job description

Designation - Executive / Sr. Executive- Authorization

Job Location - Noida

Reports To- Team Lead / Assistant Manager

Shift- Night (6:30 PM to 3:30 AM)

Key Responsibilities:

• Initiate and follow up on prior authorization requests with insurance companies for medical procedures, diagnostic tests, surgeries, and other healthcare services.
• Review patient eligibility, benefits, and insurance coverage using payer portals or calling payers.
• Coordinate with providers, clinical staff, or scheduling teams to obtain necessary clinical documentation for submitting authorization requests.
• Submit prior authorization requests via online portals, fax, or phone, depending on payer requirements.
• Track the status of pending authorizations and ensure timely follow-up to avoid service delays.
• Document all activities and communication in the client's system (EMR/PM/RCM software).
• Verify and update patient demographics, insurance information, and authorization details accurately.
• Maintain up-to-date knowledge of payer-specific authorization guidelines and changes.
• Escalate complex cases or delays in approvals to the team lead or client contact as necessary.
• Support denial prevention by ensuring accurate and complete submissions of authorization requests.

Required skill set:

• Any degree / diploma with 1 year of experience in prior authorization or insurance verification in US healthcare RCM.
• Familiarity with major US insurance carriers (Medicare, Medicaid, Commercial plans).
• Understanding of clinical terminologies, CPT, ICD-10, and HCPCS codes.
• Experience with EMR/RCM systems such as EPIC, Cerner, Athenahealth, etc.
• Excellent verbal and written communication skills.
• Ability to work in a high-volume, deadline-driven environment.