Prior Authorization Executive

Role & responsibilities :

Handle the end-to-end prior authorization process for medical procedures, services, and treatments.

Verify patient insurance eligibility and benefits before initiating authorization.

Review insurance policies to determine whether prior authorization is required.

Submit authorization requests through insurance portals, payer websites, fax, or phone.

Collect and validate required clinical and patient information for authorization submission.

Coordinate with providers, clinical teams, and insurance companies for missing documentation.

Follow up with insurance companies on pending authorization requests.

Track authorization status and maintain accurate records in the relevant system.

Communicate authorization approvals, denials, and additional documentation requirements to the appropriate teams.

Work on authorization denials and re-submissions where applicable.

Ensure authorizations are obtained within payer-specific timelines to avoid service delays and potential claim denials.

Maintain accurate documentation of authorization numbers, effective dates, expiration dates, and approved services.

Identify authorization-related issues that may impact claims processing and reimbursement.

Meet defined productivity, quality, accuracy, and turnaround-time (TAT) targets.

Follow HIPAA, payer, client, and company compliance requirements.

Escalate complex authorization issues to the appropriate team or supervisor.

Maintain confidentiality of patient and healthcare information.

Preferred candidate profile

Candidates with 1-4 years of experience in US Healthcare RCM, particularly Prior Authorization, Eligibility, Insurance Verification, or related processes.

Experience working with US insurance payers and provider offices will be preferred.

Candidates with knowledge of medical terminology and US healthcare processes are preferred.

Good communication skills and willingness to meet process targets.