Auth Executive

Designation: Executive / Sr. Executive Authorization

Job Location: Noida

Reports To: Team Lead / Assistant Manager

Shift: Night (6PM to 3 AM)

Key Responsibilities:

• 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 clients 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.

Required skill set:

• 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.