Approval Officer

Apply medical knowledge and best insurance practice while reviewing and verifying the PreApproval requests (OP/ IP) received from different departments to obtain authorizations as required by insurance companies dependent upon the plan coverage for all Insurance patients.

Responsibilities

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

Communicates payer authorization and eligibility information.

Sends payer informational correspondence.

Completes service and procedure authorizations and referrals.

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

If necessary, contacts referral physicians for more information.

Once approval is obtained, notifies the concerned staff and treating physicians.

Enters new patient information and updates data in the system.

Assists with other clerical responsibilities as needed.

Notifies branch management of concerns regarding payer coverage or service non-coverage.

Keeps track of the daily production report.

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

The supervisor and team leader monitor schedules, emergency requirements and all queries from the facility.

Guides doctors and concerned staff to follow the correct ICD, CDT and CPT codes to avoid rejections.

Qualifications

Diploma in any medical discipline or a related field.

Knowledge of medical coding standards, including ICD, CPT, DRG and HCPCS.

Minimum 2 years of experience in insurance claims management or pre-authorization processes.