Prior Authorization Executive

16 hours ago

Borivli, Maharashtra, India HANR Support Services Pvt. Ltd. Full time ₹ 2,50,000 - ₹ 7,50,000 per year

Job Summary:

The Prior Authorization Executive will be responsible for initiating and securing prior authorizations from insurance companies for medical services. This role involves coordinating with clinical teams and payers to ensure services are approved timely, enabling uninterrupted patient care.

Key Responsibilities:

  • Initiate and follow up on prior authorization requests for procedures, medications, and services.
  • Communicate with insurance payers via phone, fax, or portals to obtain approvals.
  • Coordinate with physicians, clinical staff, or scheduling teams for required documentation.
  • Use payer portals such as Availity, Navinet, and others to track auth status.
  • Maintain detailed records of all prior authorization requests and outcomes.
  • Update EHR or billing systems with approval, denial, or pending information.
  • Ensure all prior authorizations are processed within the defined turnaround time (TAT).

Required Skills:

  • Excellent verbal communication and coordination skills.
  • Familiarity with CPT/HCPCS codes, ICD codes, and payer-specific guidelines.
  • Understanding of medical necessity requirements and pre-auth policies.
  • Experience using insurance portals (e.g., Availity, Navinet) and RCM tools.
  • Ability to multitask and handle high-volume authorization workflows.
  • Good working knowledge of Microsoft applications such as Outlook, Teams, Excel, Word, and MS PowerPoint.

Desired Attributes:

  • Strong attention to detail and organizational skills.
  • Ability to work under pressure and meet strict timelines.
  • High level of professionalism and customer service mindset.
  • Familiarity with electronic health records (EHRs) and documentation best practices.

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