Medical EV & Authorization Executive

Job Title: Medical EV & Authorization Executive
Department: Healthcare RCM (Revenue Cycle Management)
Location: Makarba, Ahmedabad
Employment Type: Full-Time (Work from Office)
Shift Timing: Night Shift (6:30 PM – 3:30 AM)
Experience Required: 6 months to 3 years in Medical Eligibility Verification & Authorization

Job Summary:

We are seeking a detail-oriented and experienced Medical EV & Authorization Executive to join our growing healthcare team. The ideal candidate will be responsible for verifying patients' insurance eligibility and obtaining prior authorizations for medical procedures and services. This role is crucial in ensuring smooth claims processing and reducing insurance denials.

Key Responsibilities:

Eligibility Verification (EV):

• Verify patients' insurance coverage via online portals or by contacting payers.
• Confirm plan details including active status, co-pay, deductible, co-insurance, and coverage limits.
• Document all eligibility verification findings accurately in the internal system.

Prior Authorization:

• Obtain prior authorizations for medical procedures, tests, or medications by coordinating with insurance companies.
• Submit required documents in a timely manner for approval.
• Follow up regularly with payers to ensure authorizations are received without delay.

Coordination and Communication:

• Collaborate with healthcare providers and clients to gather any missing information.
• Maintain clear and timely communication with team members.
• Escalate issues promptly to ensure workflow efficiency.

Compliance and Documentation:

• Ensure compliance with HIPAA regulations and company policies.
• Maintain accurate records of all interactions and communications with insurance payers.

Required Skills & Qualifications:

• 6 months to 3 years of experience in Medical Eligibility Verification and Prior Authorization (US healthcare process).
• Strong verbal and written communication skills in English.
• Proficiency in navigating insurance portals and healthcare software systems.
• Basic knowledge of medical terminology and US insurance plans (PPO, HMO, Medicaid, Medicare, etc.).
• Ability to multitask, stay organized, and meet deadlines.

Benefits:

• 5-day working week
• Free meal facility
• Supportive and collaborative work culture
• Career growth opportunities

Job Types: Full-time, Permanent

Pay: ₹20,000.00 - ₹35,000.00 per month

Schedule:

• Night shift

Work Location: In person