AR Callers & Prior Auth Exe

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.