Rcm Specialist

Virtueus Healthcare Services (opc); Chennai District; On-site; INR 600,000 - 900,000; Full time

Job summary

Virtueus Healthcare Services (opc) in Chennai is seeking a Senior Executive - Authorization to manage end-to-end processing of medical service authorizations for US clients. You will submit through payer portals, verify details and maintain accurate records for timely determinations.

Ideal candidates have 4+ years in US healthcare billing/RCM and 3+ years in authorization, with strong communication, attention to detail and ability to work independently in a high-volume environment.

Qualifications

• Bachelor's degree or equivalent required.
• 4+ years US Healthcare Medical Billing/RCM experience.
• 3+ years hands-on Authorization experience preferred.

Responsibilities

• Process prior authorizations and referrals within defined TAT.
• Submit authorizations through payer portals, online systems, fax, email and phone.
• Verify patient, provider, insurance, CPT, diagnosis and service details before submission.
• Review payer-specific authorization and referral requirements.
• Ensure required clinical documentation is submitted accurately.
• Track pending, approved, denied, cancelled and expired authorizations.
• Follow up with payers and resolve delays and denials.
• Communicate authorization status to clients and participate in client calls.
• Escalate complex cases requiring additional documentation.

Skills

US healthcare authorization

Payer portals

Communication skills

Attention to detail

Independent work

CPT/HCPCS/ICD-10 knowledge

RCM/ Billing familiarity

Education

Bachelor's degree or equivalent

Tools

DrChrono

Availity

Cohere

RadMD

Job description

Role & responsibilities

Senior Executive - Authorization

Job Description:

Responsible for end-to-end processing and follow-up of medical service authorization requests for US healthcare clients.

Key Responsibilities:

• Process prior authorization and referral requests within defined TAT.
• Submit authorizations through payer portals, online systems, fax, email and phone.
• Verify patient, provider, insurance, CPT, diagnosis and service details before submission.
• Review payer-specific authorization and referral requirements.
• Ensure required clinical documentation is submitted accurately.
• Track pending, approved, denied, cancelled and expired authorizations.
• Follow up with payers and resolve authorization delays and denials.
• Communicate authorization status and critical cases to clients.
• Handle authorization tickets and participate in client calls.
• Escalate complex cases requiring additional documentation, peer-to-peer or reconsideration.
• Maintain accurate authorization records and work queues.
• Support junior team members and assist with complex cases.
• Prepare productivity, status and denial reports.
• Identify process issues and contribute to workflow improvements.

Required Skills:

• Strong knowledge of US healthcare insurance authorization and referral processes.
• Good understanding of eligibility, benefits and payer requirements.
• Knowledge of CPT, HCPCS, ICD-10 and medical terminology preferred.
• Experience with payer portals and healthcare RCM systems.
• Strong communication, follow-up and analytical skills.
• Excellent attention to detail and ability to manage high-volume work.
• Ability to work independently and meet strict TAT and quality targets.

Qualifications:

• Bachelor's degree or equivalent.
• 4+ years of US Healthcare Medical Billing/RCM experience.
• 3+ years of hands-on Authorization experience preferred.

Keywords:

US Healthcare, Medical Billing, RCM, Prior Authorization, Referral, Insurance Verification, CPT, HCPCS, ICD-10, Pain Management, Workers Compensation, DrChrono, Availity, Cohere, RadMDesponsibilities

Preferred candidate profile

• 35 years of experience in US Healthcare RCM, Medical Billing, or Healthcare Operations.
• Minimum 2–3 years of hands-on experience in insurance authorization and referral management.
• Strong experience handling prior authorizations from submission through final determination.
• Experience working with US commercial, Medicare, Medicaid and preferably Workers Compensation payers.
• Strong knowledge of insurance eligibility, benefits, referral requirements and authorization requirements.
• Experience using payer portals, online authorization systems, fax, email and telephone-based authorization processes.
• Good working knowledge of CPT, HCPCS, ICD-10 and medical terminology.
• Experience reviewing clinical documentation and payer requirements before submitting authorization requests.
• Strong follow-up skills for pending, denied, partially approved and delayed authorizations.
• Ability to identify missing information and proactively resolve issues that may delay authorization.
• Experience handling complex, urgent and high-priority authorization cases.
• Strong communication skills with insurance representatives, clients and internal teams.
• Comfortable handling client tickets, emails, chats and participating in client calls.
• Strong documentation, tracking and work queue management skills.
• Ability to meet strict TAT, productivity and accuracy targets in a high-volume environment.
• Experience mentoring junior team members and supporting complex case resolution.
• Strong analytical and problem-solving skills with a proactive approach to denial prevention.
• Candidates with experience in Pain Management, Workers Compensation, DrChrono, Availity, Cohere or RadMD will be preferred.