Approval Officer
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DUTIES AND RESPONSIBILITIES :
• Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits
• Respond to Insurance/ TPA queries and liaise with concerned department without ny delay.
• Responsible for receiving, evaluating and escalating second opinion cases and case management
• Perform night shift duty and on public holidays as per duty roster.
• Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
• Handle Auditing Process. Arrange required documents and papers and check with coders in order to assist the external Auditors
• Attend Meetings and Presentation
• Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
• Prepare cost estimate for procedures for Cash Patient
• To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
• Managing and handling pending cases (if any) to the next shift colleagues.
• Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
Requirements
- •Evaluate pre-approval requests for medical necessity
- •Accurately code service descriptions using accepted medical coding rules
- •Respond to insurance/TPA queries
- •Liaise with concerned departments
- •Perform night shift duty and on public holidays
- •Prepare daily activity reports
- •Assist management in monthly reports
- •Handle auditing process
Nice to Have
- •Train Front office, Receptionist and Nurses and keep them updated about Insurance details.
- •Prepare cost estimate for procedures for Cash Patient
- •To adjust duties in case of any sudden/ emergency unplanned leaves by colleagues.
- •Managing and handling pending cases (if any) to the next shift colleagues.
- •Performs any other jobs or duties assigned by the HOD from time to time within the scope of job title
Responsibilities
- •Evaluate the Pre Approval requests from medical necessity for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits
- •Respond to Insurance/ TPA queries and liaise with concerned department without ny delay.
- •Responsible for receiving, evaluating and escalating second opinion cases and case management
- •Perform night shift duty and on public holidays as per duty roster.
- •Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.
- •Handle Auditing Process.
- •Arrange required documents and papers and check with coders in order to assist the external Auditors
- •Attend Meetings and Presentation
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60 seconds. $3.99 one-time.