- Accurate provision of product/service information and documentation research before client interaction.
- Assurance of insurance eligibility and benefits confirmation through online platforms and telephonic verification.
- Updating and maintaining policy information in the Electronic Medical Record (EMR), inclusive of necessary notification forms.
- Assurance of requisite pre-authorization document reception before treatment initiation.
- Commencement of Authorization for appointments & procedures, adhering to Therapy services protocols.
- Thorough clinical document review for pre-authorization and initiation of pre-determination submission.
- Engage with insurance companies for procedure pre-authorization requests and conduct diligent follow-ups.
- Prioritize the utilization of Insurance web portals for authorization requests.
- Graduate in a relevant field.
- 1-6 years’ experience in Eligibility Verification and Prior Authorization in US healthcare.
- Profound knowledge of the prior authorization processes.
- Willingness to work from the office.
- Availability to work during the night shift (6:00 PM IST to 3:00 AM IST).
Preferred Qualifications & Skills
- Prior working experience in US healthcare Revenue Cycle Management (RCM) and medical billing, particularly in specialties like Cardiology, Radiology, and Orthopedics.
- Proficiency in Eligibility Verification (EV), Authorization, and Account Receivable (AR).
- Stellar communication skills.
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