Approval Officer

Job Description

• Evaluate the Pre Approval 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
• Response to Insurance/ TPA queries and liaise with concerned department.
• Responsible for receiving, evaluating and escalating second opinion cases and case management
• Perform night shift duty to sustain any issues and queries related to Authorization department
• Prepares reports of daily activity as requested for management and assists management in monthly reports as requested
• GENERAL RESPONSIBILITIES:
• Work in all shifts as scheduled by the Head of Department.
• Strictly adheres to organization’s regulations and policies especially those related
  
  

to infection control, patient safety, OSHMS, DOH, JCI and ISO.

• Supports Continuous Quality Improvement and participates and contributes to all
  
  

the quality assurance activities of the service.

• Participates and contributes in scheduled in-service training programs.
• Exercises effective interpersonal skills in dealings with department staff, associates
  
  

and Management.

• Maintains confidentiality as per the agreement signed.
• Demonstrates the ability to listen to others in promoting effective communication.
• Develops thorough understanding of policies and procedures of the hospital and
  
  

demonstrates respect for them.

• Carries out other duties when requested by the Head of department
  
  

Responsibilities

• Evaluate the Pre Approval 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
• Response to Insurance/ TPA queries and liaise with concerned department.
• Responsible for receiving, evaluating and escalating second opinion cases and case management
• Perform night shift duty to sustain any issues and queries related to Authorization department
• Prepares reports of daily activity as requested for management and assists management in monthly reports as requested
• GENERAL RESPONSIBILITIES:
• Work in all shifts as scheduled by the Head of Department.
• Strictly adheres to organization’s regulations and policies especially those related
  
  

to infection control, patient safety, OSHMS, DOH, JCI and ISO.

• Supports Continuous Quality Improvement and participates and contributes to all
  
  

the quality assurance activities of the service.

• Participates and contributes in scheduled in-service training programs.
• Exercises effective interpersonal skills in dealings with department staff, associates
  
  

and Management.

• Maintains confidentiality as per the agreement signed.
• Demonstrates the ability to listen to others in promoting effective communication.
• Develops thorough understanding of policies and procedures of the hospital and
  
  

demonstrates respect for them.

• Carries out other duties when requested by the Head of department
  
  

Qualifications

• Bachelor Degree in Medicine (MBBS) graduate from a recognized university.
• Experience in Insurance Claims management/adjudication (minimum 2 years)
• Experience in Medical Coding ICD, CPT, DRG and HCPCS.
• Excellent command of oral and written English.
• Flexible and able to work under pressure
• Excellent knowledge of Microsoft applications