US Medical Billing Process jobs in Mumbai, Maharashtra

We’re looking for talented professionals to join our team in an Authorization (Auth) L1 Appeals role.

Role: Auth L1 Appeals
Experience: [1-2 years]
Location: Sakinaka, Mumbai
Employment: [Full-time / Contract]

What we’re looking for:

• Experience in healthcare authorization and appeals
• Strong understanding of payer processes and medical necessity
• Ability to review, analyze, and resolve authorization/appeal cases
• Strong attention to detail and documentation skills
• Excellent communication and problem-solving abilities

Key Responsibilities

• Clinical Review: Examine medical records, physician notes, and treatment plans to validate medical necessity.
• Criteria Application: Use standard medical guidelines like InterQual, MCG, or CMS regulations (NCD/LCD) to assess level-of-care and authorization denials.
• Appeal Submission: Draft and submit structured, evidence-based appeal arguments to overturn prior authorization and claims denials.
• Peer-to-Peer Coordination: Coordinate and schedule peer-to-peer reviews between attending physicians and payer medical directors.
• Regulatory Compliance

Pay: ₹25,000.00 - ₹32,000.00 per hour

Benefits:

• Flexible schedule
• Provident Fund

Work Location: In person