Approval Officer

Responsible for reviewing clinical documentation and assigning standardized medical codes to diagnoses, procedures, and treatments for billing, insurance claims, and maintaining accurate medical records.

• Follow the mandatory SOP, checklist and relevant payer and coding guidelines.

• Checking demographic details of patient and make sure the front desk should select the proper regulatory policy (DHPO or RIAYATI)

• Proper documentations are entered in the Chart/ EMR/ Claim form by the doctors.

• Supporting details/ justification available in EMR of all investigation done.

• Checking all CPT codes entered are correct based on CPT guidelines.

• Checking excluded ICD and CPT based on Coding guidelines.

• Approved services and rendered services are match.

• Ensuring all requested investigations are done and invoiced.

• Check the claim with correct Receiver and Payer name before finalizing the bill.

• Check the claim with correct Patient Copay application.

• Ensure all claims are submitted to insurance company.

• Check the payer’s name, rate plan and plan name selected properly.

• College Diploma - Any discipline or related fields.

• Coding Certification, CPC – Certified Professional Coder (AAPC)

Proficiency in:

• ICD-10-CM (diagnosis codes)

• CPT (procedure codes)

HCPCS Level II (supplies, equipment, services)