Key Responsibilities

  • 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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