Urgent Hiring - US Healthcare Eligibility & Prior Authorization

Martin Knowledge Solutions; Hyderabad; On-site; INR 350,000 - 550,000; Full time

Job summary

MKS Health in Hyderabad, India, is seeking experienced professionals for US Healthcare Eligibility, Benefits Verification, and Prior Authorization. Join a focused team handling verification of insurance coverage, benefits, copayments, and authorization requirements for US payers.

Responsibilities include processing Prior Authorization requests, tracking statuses, communicating with payer portals and US representatives, and maintaining meticulous documentation with reference numbers and dates.

Qualifications

• Minimum 1–7 years in US Healthcare Eligibility, Benefits Verification, Prior Authorization, or Medical Billing/RCM.

Responsibilities

• Verify patient eligibility and insurance coverage.
• Verify benefits, copay, deductible, coinsurance, out-of-pocket, visit limits, and coverage limitations.
• Confirm in-network and out-of-network benefits and provider network status.
• Determine if services require Prior Authorization, Precertification, Referral, or Pre-Authorization.
• Initiate and process Prior Authorization requests with insurance companies.
• Follow up on pending authorization requests via payer portals.
• Track authorization numbers, approved visits/units, dates, and expiration dates.
• Document eligibility, benefits, and authorization information accurately in systems.

Skills

US Healthcare Eligibility

Benefits Verification

Prior Authorization

Documentation & Payer Portals

Communication Skills

Job description

MKS Health is looking for experienced professionals in US Healthcare Eligibility, Benefits Verification, and Prior Authorization.

The candidate will be responsible for verifying patient insurance coverage, benefits, and authorization requirements and coordinating with US insurance payers to ensure accurate and timely verification.

Key Responsibilities

• Verify patient eligibility and insurance coverage.
• Verify insurance benefits, copay, deductible, coinsurance, out-of-pocket amounts, visit limits, and coverage limitations.
• Verify in-network and out-of-network benefits and provider network status.
• Determine whether services require Prior Authorization, Precertification, Referral, or Pre-Authorization.
• Initiate and process Prior Authorization requests with insurance companies.
• Follow up with insurance companies and payer portals regarding pending authorization requests.
• Track authorization numbers, approved visits/units, effective dates, and expiration dates.
• Review payer websites and portals to obtain accurate eligibility and benefit information.
• Contact US insurance representatives to clarify coverage, benefits, and authorization requirements.
• Accurately document eligibility, benefits, and authorization information in the appropriate system.
• Maintain detailed notes including reference numbers, representative names, call dates, and authorization details.
• Identify benefit restrictions, exclusions, and authorization requirements.
• Escalate discrepancies or complex insurance issues to the appropriate team.
• Complete eligibility, benefits, and authorization verification within the required turnaround time.
• Meet assigned productivity, accuracy, and quality targets.

Required Skills & Experience

• 1 to 7 years of experience in US Healthcare Eligibility, Benefits Verification, Prior Authorization, or Medical Billing/RCM.
• Strong experience in Eligibility & Benefits Verification.
• Hands-on experience with Prior Authorization / Precertification preferred.
• Good understanding of:
  • Eligibility and coverage
  • Deductibles
  • Copays
  • Coinsurance
  • Out-of-pocket amounts
  • In-Network / Out-of-Network benefits
  • Visit limits
  • Referrals
  • Prior Authorization requirements
• Experience working with US insurance payers and payer portals.
• Good verbal and written communication skills.
• Strong attention to detail and documentation skills.
• Ability to communicate professionally with US insurance representatives.
• Immediate joiners preferred.

Important Company Policies

• Work Mode: Work From Office only.
• Work Location: Uppal, Hyderabad.
• Shift Timing: 05:30 PM IST to 02:30 AM IST (US Night Shift).
• Cab / Transportation Facility: Not provided.
• PF: Not provided.
• Candidates must be comfortable with the above work location, shift timing, and company policies.