Executive / Sr Executive / Prior Authorization ( US Healthcare)

Access Healthcare; Dadri; On-site; INR 350,000 - 550,000; Full time

Job summary

Access Healthcare Noida seeks an Executive/Sr. Executive- Authorization to manage US prior authorizations and insurance verifications.

You will coordinate with providers, review eligibility, and submit requests via payer portals, fax, or phone, ensuring timely approvals. Ideal candidates have 1 year of US RCM experience, familiarity with CPT/ICD-10/HCPCS, and hands-on use of EMR/RCM systems such as EPIC, Cerner, or Athenahealth.

Qualifications

• 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 CPT, ICD-10, and HCPCS codes; experience with EMR/RCM systems such as EPIC/Cerner/Athenahealth.

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.

Skills

US healthcare knowledge

CPT/ICD-10/HCPCS coding

EMR/RCM operating experience

Verbal and written communication

Deadline-driven work

Education

Any degree/diploma

Tools

EPIC

Cerner

Athenahealth

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.