- Verify patient insurance eligibility and benefits prior to scheduled appointments or procedures using payer portals, IVR systems, and direct payer calls
- Confirm coverage details including deductibles, co-pays, co-insurance, out-of-pocket maximums, network status, and plan limitations
- Identify primary, secondary, and tertiary insurance coverage and coordinate benefits accordingly
- Update patient demographic and insurance information accurately in the Practice Management / EHR system
- Flag coverage issues, inactive policies, or coordination of benefits (COB) discrepancies and communicate findings to the billing team in a timely manner
- Initiate and follow up on prior authorization requests for procedures, surgeries, specialist referrals, and diagnostic tests with commercial and government payers
- Compile and submit clinical documentation required by payers to support authorization requests (medical necessity, physician notes, test results)
- Track authorization status and communicate approvals, denials, and pending requests to the clinical and billing teams
- Manage authorization renewals, extensions, and retro-authorizations where applicable
- Maintain accurate and complete authorization logs; ensure all approvals are documented in the system before claim submission
- Ensure full compliance with HIPAA regulations and maintain confidentiality of all patient health information (PHI)
Eligibility & Requirements
- Education: Graduate in any discipline (B.Sc. / B.Com / BBA or equivalent preferred)
- 1–2 years of experience in US healthcare EVA processes within an RCM / BPO environment
- Working knowledge of commercial payers (Aetna, Cigna, UHC, BCBS) and government payers (Medicare, Medicaid)
- Proficiency in payer portals, IVR systems, and EHR / Practice Management software (e.g., AdvancedMD, Kareo, Athena, or similar)
- Strong verbal and written English communication skills; ability to interact effectively with US-based payers and clinical staff
Pay: ₹22,000.00 - ₹30,000.00 per month
Benefits:
- Food provided
- Provident Fund
Work Location: In person
