Key Responsibilities:
- Contact insurance companies (via outbound calls) to follow up on unpaid or denied claims.
- Review and analyze EOBs (Explanation of Benefits) and identify reasons for denials or delays.
- Take corrective actionsresubmissions, appeals, or adjustmentsbased on payer responses.
- Update billing software with clear notes on call outcomes and claim status.
- Meet daily productivity and quality benchmarks.
- Follow HIPAA guidelines and maintain compliance at all times.
Requirements:
- Good spoken English (US accent preferred).
- Understanding of US healthcare terms and insurance types (Medicare, Medicaid, commercial).
- Experience in AR calling / denial management preferred (freshers can be trained).
- Strong attention to detail and time management skills.
2. Role: Prior Authorization Executive
Key Responsibilities:
- Initiate and obtain prior authorizations from insurance carriers for procedures, medications, or services.
- Review patient eligibility and benefits through insurance portals and calls.
- Ensure all documentation and clinical notes are submitted accurately for approval.
- Communicate with healthcare providers and insurance reps to track authorization status.
- Maintain authorization logs and escalate pending requests before scheduled services.
- Handle both pre-certification and retro-authorization workflows depending on the specialty.
Requirements:
- Excellent communication (written and verbal) and coordination skills.
- Basic understanding of insurance verification and medical necessity requirements.
- Familiarity with EHR systems like Epic, Cerner, or Athena is a plus.
- Prior experience in prior auth / eligibility verification is preferred but not mandatory.
