Walk-in | Senior Executive / Executive - Prior Authorization

IKS Health Limited.; Coimbatore District; On-site; INR 320,000 - 520,000; Full time

Job summary

IKS Health Limited in Coimbatore (Saravanampatti) invites experienced Prior Authorization professionals to join our US Healthcare team. You will initiate and submit PA requests, gather medical documentation, and liaise with insurers to secure timely approvals.

This role emphasizes accuracy, speed, and collaboration with clinic staff and insurance directors, with targets for volume and turnaround. Strong English communication and knowledge of ICD-10/CPT/HCPCS are essential.

Qualifications

• Experience: 1 to 4 years in US healthcare Prior Authorization or Pre-Certification.
• Education: Any Graduate; B.Com, B.Sc, BBA, BA or Postgraduate; B.Pharm/M.Pharm/Life Science preferred.
• Insurance knowledge: Familiar with major payers (Aetna, BCBS, Cigna, Humana, UnitedHealthcare, Medicare, Medicaid).
• Medical terminology: Knowledge of ICD-10, CPT, HCPCS related to authorizations.
• Software: Experience with RCM or EHR systems like Epic, eCW, Allscripts; Availity/Navinet is a plus.
• Communication: Strong spoken and written English with professional telephone etiquette for US calls.

Responsibilities

• Initiate and submit prior authorization requests to US insurance companies via portals, phone, or fax.
• Collect and verify clinical documentation, demographics, and insurance information from providers.
• Follow up with insurers to track status and secure timely approvals.
• Update patient accounts and internal systems with authorization details, approval numbers, and dates.
• Meet daily and weekly targets for volume, accuracy, and turnaround time.
• Handle complex prior authorization cases, retro-authorizations, and urgent requests.
• Review denials and prepare appeals with medical necessity documentation.
• Guide junior team members as SME and resolve process bottlenecks.
• Coordinate with clinic coordinators, physicians, and insurance medical directors to resolve disputes.
• Monitor KPIs and report productivity and denial trends to management.

Skills

Prior Authorization

US Healthcare

Communication

Medical Terminology

Education

Any Graduate (B.Com, B.Sc, BBA, BA)

B.Pharm / M.Pharm / Life Science graduates preferred

Tools

Epic

eClinicalWorks (eCW)

Allscripts

Availity

Navinet

Job description

Point Of Contact for Interview Scheduling :-

Pavan Kalyan - 9381182380

Jeshima - 8883060362

Role : Prior Authorization/ Pre Auth

Location : Coimbatore - Saravanampatti

Role & responsibilities

• Initiate and submit prior authorization requests to US insurance companies via web portals, phone, or fax.
• Collect and verify all necessary clinical documentation, demographics, and insurance information from providers.
• Follow up regularly with insurance companies to track status and secure timely approvals.
• Update patient accounts and internal workflow systems with accurate authorization details, approval numbers, and valid dates.
• Meet daily and weekly targets for volume, accuracy, and turnaround time.
• Handle complex prior authorization cases, retro-authorizations, and urgent expedited requests.
• Review and analyze insurance denials related to prior authorization; prepare and submit formal appeals with required medical necessity documentation.
• Act as a Subject Matter Expert (SME) to guide junior team members and resolve process bottlenecks.
• Maintain direct communication with clinic coordinators, physicians, or insurance medical directors to resolve disputes.
• Monitor key performance metrics and report daily productivity and denial trends to management.

Preferred candidate profile

• Experience: 1 to 4 years of core experience in US Healthcare Prior Authorization or Pre-Certification.
• Education: Any Graduate (B.Com, B.Sc, BBA, BA) / Post Graduate. B.Pharm, M.Pharm, or Life Science graduates are highly preferred.
• Insurance Knowledge: Strong understanding of US major insurance payers (Aetna, Blue Cross Blue Shield, Cigna, Humana, UnitedHealthcare, Medicare, Medicaid).
• Medical Terminology: Sound knowledge of ICD-10, CPT, and HCPCS codes related to authorizations.
• Software Skills: Experience working with RCM software or EHR systems like Epic, eClinicalWorks (eCW), Allscripts, or clearinghouses like Availity and Navinet.
• Communication: Excellent spoken and written English communication skills, with professional telephone etiquette for calling US insurance reps.