Client Partner – Prior Authorization

2 weeks ago

Noida, Uttar Pradesh, India Access Healthcare Services Pvt Ltd Full time ₹ 9,00,000 - ₹ 12,00,000 per year
Job Location: Noida, India
Job Description
  • Initiate and follow up on prior authorization requests with insurance companies for medical procedures, diagnostic tests, surgeries, and other healthcare services.
  • Review patient eligibility, benefits, and insurance coverage using payer portals or calling payers.
  • Coordinate with providers, clinical staff, or scheduling teams to obtain necessary clinical documentation for submitting authorization requests.
  • Submit prior authorization requests via online portals, fax, or phone, depending on payer requirements.
  • Track the status of pending authorizations and ensure timely follow-up to avoid service delays.
  • Document all activities and communication in the client's system (EMR/PM/RCM software).
  • Verify and update patient demographics, insurance information, and authorization details accurately.
  • Maintain up-to-date knowledge of payer-specific authorization guidelines and changes.
  • Escalate complex cases or delays in approvals to the team lead or client contact as necessary.
  • Support denial prevention by ensuring accurate and complete submissions of authorization requests.
Job Requirements
  • Any degree / diploma with 1 year of experience in prior authorization or insurance verification in US healthcare RCM.
  • Familiarity with major US insurance carriers (Medicare, Medicaid, Commercial plans).
  • Understanding of clinical terminologies, CPT, ICD-10, and HCPCS codes.
  • Experience with EMR/RCM systems such as EPIC, Cerner, Athenahealth, etc.
  • Excellent verbal and written communication skills.
  • Ability to work in a high-volume, deadline-driven environment.

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