The US Medical Billing Authorization Executive is responsible for obtaining, verifying, and tracking prior authorizations and referrals from insurance companies for medical services, procedures, diagnostic tests, and medications. The role ensures that required authorizations are secured before services are rendered, helping prevent claim denials and ensuring compliance with US healthcare payer guidelines.

2. Key Responsibilities

Obtain prior authorizations and referrals from US health insurance companies for medical procedures, diagnostic tests, treatments, and other healthcare services.
Verify patient eligibility, insurance coverage, benefits, and authorization requirements.
Contact insurance payers via phone, payer portals, and electronic systems to initiate and follow up on authorization requests.
Review physician orders, clinical documentation, CPT codes, ICD-10-CM codes, and other supporting information required for authorization.
Submit authorization requests accurately and within payer-specific timelines.
Follow up on pending, delayed, denied, or incomplete authorization requests.
Coordinate with physician offices, medical providers, clinical teams, and insurance companies to obtain missing documentation.
Maintain accurate records of authorization reference numbers, approval dates, validity periods, approved units, and service limitations.
Monitor authorization status and validity to ensure services are performed within the approved period.
Escalate urgent cases and authorization denials to the appropriate team or supervisor.
Identify authorization-related denial trends and support corrective actions to reduce revenue leakage.
Meet daily productivity, quality, turnaround-time, and compliance targets.
Maintain patient confidentiality and comply with HIPAA requirements and company policies.

3. Required Skills and Qualifications

Any graduate degree is preferred.
Experience in US healthcare, medical billing, or Revenue Cycle Management (RCM) is preferred.
Knowledge of US health insurance plans, including Medicare, Medicaid, and commercial insurance.
Understanding of prior authorization, referral management, eligibility verification, and benefits verification.
Familiarity with CPT, ICD-10-CM, and HCPCS codes is an advantage.
Good English communication skills and professional telephone etiquette.
Ability to use payer portals, healthcare billing software, and Microsoft Excel.
Strong attention to detail, follow-up skills, and time management.
Ability to work in a US time-zone-aligned shift.

4. Experience Requirements

Level

Preferred Experience

Entry Level

0–1 year; training may be provided

Authorization Executive

1–3 years in US healthcare authorization or RCM

Senior Authorization Executive

3+ years with complex authorizations and denial follow-up

5. Key Performance Indicators (KPIs)

Number of authorization requests processed per day.
Authorization turnaround time (TAT).
First-time authorization approval rate.
Accuracy of authorization submissions and documentation.
Pending authorization follow-up and resolution rate.
Reduction in authorization-related claim denials.
Quality audit scores and compliance with payer requirements.
Adherence to attendance, productivity, and confidentiality standards.

6. Preferred Technical Knowledge

US insurance payer portals and provider websites.
Electronic health records (EHR) and practice management systems.
Prior authorization workflows for outpatient services, imaging, surgeries, and specialist consultations.
Authorization tracking tools and denial management workflows.
Knowledge of electronic authorization standards, including applicable HIPAA transactions.

Pay: ₹10,000.00 - ₹40,000.00 per month

Benefits: