Approval Officer

Job description

1. Evaluate the pre-authorization 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.

2. Response to Insurance/ TPA queries and liaise with concerned department.

1. Responsible for receiving, evaluating and escalating second opinion cases and case management.

1. Perform night shift duty to sustain any issues and queries related to Authorization department.

2. Prepares reports of daily activity as requested for management and assists management in monthly reports as requested.

• Bachelor's Degree in Medicine (MBBS) from a recognized university.

• Minimum 2 years of experience in insurance claims management/adjudication.

• Experience in medical coding (ICD, CPT, DRG and HCPCS).

• Excellent command of written and spoken English.

• Flexible and able to work under pressure.

• Excellent knowledge of Microsoft Office applications.

• Evaluate pre-authorization requests for medical necessity based on the medical data provided and accurately code service description codes in accordance with accepted medical coding rules, medical guidelines and the policy's schedule of benefits.

• Respond to insurance/TPA queries and liaise with the concerned departments.

• Receive, evaluate and escalate second opinion cases and case management requests.

• Perform night shift duties to address any issues and queries related to the Authorization Department.

• Prepare daily activity reports as requested by management and assist with monthly reporting.