Prior Authorization Executive

Job Summary

The Prior Authorization Executive is responsible for obtaining pre-approvals from insurance companies for medical procedures, treatments, and medications. This role ensures timely authorization to avoid delays in patient care and reimbursement while maintaining compliance with payer guidelines.

Key Responsibilities

• Initiate and process prior authorization requests via portals, phone calls, or fax
• Verify patient insurance eligibility and benefits before submission
• Review patient records, clinical documents, and physician orders
• Submit accurate authorization requests with required medical documentation
• Follow up with insurance companies for pending approvals
• Handle denials and initiate appeals with proper justification
• Maintain accurate records of all authorization activities
• Communicate authorization status with providers, patients, and internal teams
• Ensure compliance with payer policies, CPT/ICD codes, and medical necessity guidelines

Required Skills & Qualifications

• Bachelor’s degree (Healthcare Administration, Business, or relevant field preferred)
• 1–3 years of experience in Prior Authorization / Medical Billing / RCM
• Strong knowledge of:
• Insurance verification
• Prior authorization process
• Medical terminology
• CPT & ICD-10 coding
• Excellent communication and coordination skills
• Strong attention to detail and time management
• Ability to work in a fast-paced, target-driven environment
• Proficiency in MS Office and healthcare software (EMR/EHR systems)

Key Competencies

• Analytical & problem-solving skills
• Multitasking ability
• Strong follow-up and negotiation skills
• Customer service orientation
• Ability to meet deadlines and SLAs

KPIs / Performance Metrics

• Authorization approval rate
• Turnaround time (TAT)
• First-pass success rate
• Accuracy & compliance
• Daily productivity targets

Working Conditions

• Night shift / US healthcare shift
• Office-based

Career Path

• Prior Authorization Executive
• Senior Authorization Executive
• Team Lead – Authorization
• RCM Manager

Job Type: Full-time

Pay: Rs40,000.00 - Rs60,000.00 per month

Work Location: In person