Healthcare Professionals Sought for Medical Claims and Prior Authorizations

2 days ago

Mumbai Chennai Hyderabad Secunderabad Telangana, India beBeePrior Full time
Healthcare Professionals Sought for AR Calling and Prior Authorization Roles

We are looking for experienced healthcare professionals to join our team as AR Callers and Prior Authorization Executives. As an AR Caller, you will be responsible for contacting insurance companies to follow up on unpaid or denied claims, reviewing EOBs to identify reasons for denials or delays, and taking corrective actions based on payer responses.

Key Responsibilities:

  • Contact insurance companies via outbound calls to follow up on unpaid or denied claims.
  • Review and analyze EOBs to identify reasons for denials or delays.
  • Take corrective actions—resubmissions, appeals, or adjustments—based on payer responses.
  • Update billing software with clear notes on call outcomes and claim status.
  • Meet daily productivity and quality benchmarks.
  • Follow HIPAA guidelines and maintain compliance at all times.

Requirements:

  • Good spoken English (US accent preferred).
  • Understanding of US healthcare terms and insurance types (Medicare, Medicaid, commercial).
  • Experience in AR calling/denial management preferred (freshers can be trained).
  • Strong attention to detail and time management skills.

Prior Authorization Executive Role Summary:

As a Prior Authorization Executive, you will be responsible for initiating and obtaining prior authorizations from insurance carriers for procedures, medications, or services, reviewing patient eligibility and benefits through insurance portals and calls, ensuring all documentation and clinical notes are submitted accurately for approval, communicating with healthcare providers and insurance reps to track authorization status, maintaining authorization logs, and escalating pending requests before scheduled services.

Key Responsibilities:

  • Initiate and obtain prior authorizations from insurance carriers for procedures, medications, or services.
  • Review patient eligibility and benefits through insurance portals and calls.
  • Ensure all documentation and clinical notes are submitted accurately for approval.
  • Communicate with healthcare providers and insurance reps to track authorization status.
  • Maintain authorization logs and escalate pending requests before scheduled services.
  • Handle both pre-certification and retro-authorization workflows depending on the specialty.

Requirements:

  • Excellent communication (written and verbal) and coordination skills.
  • Basic understanding of insurance verification and medical necessity requirements.
  • Familiarity with EHR systems like Epic, Cerner, or Athena is a plus.
  • Prior experience in prior auth/eligibility verification is preferred but not mandatory.

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