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RiskGen-CoreRiskGen-i

Medical Benefits & Authorization Executive

Responsible for securing prior authorizations for ordered procedures by coordinating with U.S. commercial payers and ensuring compliance with medical policy and reimbursement requirements Jobs Responsible for securing prior authorizations for ordered procedures by coordinating with U.S. commercial payers and ensuring compliance with medical policy and reimbursement requirements. .

Job Description

Key Responsibilities

  • Evaluate clinical documentation to confirm medical necessity and ensure compliance with payer-specific coverage guidelines.
  • Prioritize authorization requests according to urgency, procedure type, and payer turnaround requirements.
  • Process prior authorization requests through payer portals and phone-based follow-ups while tracking outstanding cases.
  • Maintain current knowledge of payer requirements, authorization protocols, and supporting documentation standards.
  • Coordinate appeals for denied or partially approved requests and facilitate timely resolution.
  • Serve as a point of contact for clinics and internal teams regarding authorization status and payer-related inquiries.
  • Review CPT and ICD-10 codes associated with ordered services to ensure coding accuracy and reimbursement readiness.
  • Manage a high-volume workload with a strong focus on quality, timeliness, and regulatory compliance.

Qualifications

  • 2–4 years of experience in prior authorization or utilization management within the U.S. healthcare sector.
  • Solid understanding of authorization processes, denial handling, and payer reimbursement methodologies.
  • Previous experience in healthcare revenue cycle operations or authorization services is preferred.
  • Bachelor’s degree or an equivalent combination of education and relevant work experience.

Skills

  • Strong analytical thinking with excellent attention to detail and problem-solving capabilities.
  • Proficiency in Microsoft Office tools, including Word, Excel, and Outlook.
  • Effective written and verbal communication skills with the ability to collaborate across functions.
  • Ability to prioritize competing tasks, work independently, and thrive in a fast-paced environment.

Additional information

  • Training will be provided on client-specific systems, workflows, and payer requirements.
  • Success in this role requires exceptional documentation accuracy and strict adherence to compliance standards.
  • Gain valuable exposure to U.S. healthcare payer processes and collaborate closely with clinical and authorization teams.

Highlights

Bag Type
Full-Time
Location Location
Mysore Office
FunctionsDepartment
Prior Authorization
Posted Working Day
Monday To Friday
AdminShift
Night Shift
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