Approval Officer

Handling the rejected pre-authorization and get required justification from the treating doctor to resend it to Insurance Company and obtain the approval.

Ensure that the details of the Pre-Authorization Requests are in line with the regulators’ standards especially the claim adjudication Rules and Business Rules

• Verifies customers' insurance eligibility and authorization in a timely and accurate manner

• Communicates payer authorization and eligibility information.

• Sends payer informational correspondence.

• Complete service and procedure authorizations and referrals

• Review the patient's medical history and insurance coverage for approval.

• If necessary, contact referral physicians for more information.

• Once approval is obtained, the concerned staff and treating physicians should be notified.

• Enter new patient information and update data in our system.

• As needed, assist with other clerical responsibilities.

• Notifies branch management of concerns with payer coverage or other service noncoverage.

• Keep track of the daily production report.

• Keep the pending approval monitoring system updated for the next day's follow-up.

• The supervisor and team leader will monitor the schedules and emergency requirements and all the quires from the facility.

• Guide the doctors and concerned staff to follow the correct ICD, CDT and CPT codesto avoid the rejection

• College Diploma - Any discipline or related fields.

• Proficiency in medical coding standards: ICD, CPT, DRG, HCPCS

Experience in insurance claims management or pre-authorization (approval) processes, typically 2+ years