Prior Authorization Executive

2 weeks ago

Pune, India 3Gen Consulting Full time

Department: Revenue Cycle

Designation: Medical Benefits & Authorization Executive

Experience Required: 2-4 years

Job Location: Pune

Shift: India Night Shift / US Shift

**Job Role**:

- Review chart document to ensure patient meets medical policy guidelines.
- Prioritize incoming authorization requests according to urgency.
- Obtain authorization via payer website or by phone and follow-up regularly on pending cases.
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
- Initiate appeals for denied authorizations.
- Respond to clinic questions regarding payer medical policy guidelines.
- Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order
- Contact patients to discuss authorization status (if required)

**Job Requirements**:

- UG, Graduate or Postgraduate Degree
- Knowledge of US healthcare domain
- Knowledge of Pre-Auth/Referral
- Proficient use of CPT and ICD-10 codes
- Calling etiquettes
- Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

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