✨ AI Summary
The Approval Officer role involves reviewing and verifying Pre-Approval requests for medical procedures, ensuring they align with insurance company policies and regulatory standards. Key responsibilities include applying medical knowledge and insurance best practices, handling rejected requests by obtaining justifications from treating doctors, and preparing daily and monthly activity reports. The role also requires accurate medical coding using ICD, CPT, DRG, and HCPCS, responding to insurance queries, and potentially performing night shifts.
Qualifications include a Bachelor’s Degree in Medicine (MBBS) and a minimum of 2 years of experience in insurance claims management or adjudication. Proficiency in medical coding and strong command of English are essential. The candidate should be flexible, able to work under pressure, and proficient in Microsoft Office applications. The role also emphasizes adherence to OSH and infection control policies.
Requirements
Bachelor’s Degree in Medicine (MBBS), with a minimum of 2 years of experience in Insurance Claims Management/Adjudication. Proven experience in Medical Coding, including ICD, CPT, DRG, and HCPCS. Excellent command of spoken and written English. Flexible and able to work effectively under pressure. Excellent proficiency in Microsoft Office applications.
Description
2.1 Apply medical knowledge and best insurance practice while reviewing and verifying the Pre Approval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients. Ensure that the details of the Pre Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules.
2.2 Handling the rejected pre authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.
2.3 Prepares reports of daily activity as requested for management and assists management in month end reporting as requested.